Provider Demographics
NPI:1407316755
Name:MCKINNEY, KEVIN EDWARD (CRNP)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:EDWARD
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-1204
Mailing Address - Country:US
Mailing Address - Phone:814-501-7090
Mailing Address - Fax:814-643-3417
Practice Address - Street 1:51 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1204
Practice Address - Country:US
Practice Address - Phone:814-501-7090
Practice Address - Fax:814-643-3417
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020164363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP020164OtherPA SBON