Provider Demographics
NPI:1568279305
Name:KOERING, MCKINLEIGH (CNP)
Entity type:Individual
Prefix:
First Name:MCKINLEIGH
Middle Name:
Last Name:KOERING
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MCKINLEIGH
Other - Middle Name:
Other - Last Name:RUDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2447 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT RIPLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56449-1432
Mailing Address - Country:US
Mailing Address - Phone:218-839-0047
Mailing Address - Fax:
Practice Address - Street 1:13045 FALCON DR STE 100
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-4201
Practice Address - Country:US
Practice Address - Phone:218-829-9307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12026363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health