Provider Demographics
NPI:1588861421
Name:MCKINNEY, STACY LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:PINTAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:975 E. THIRD STREET
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-8988
Mailing Address - Fax:423-778-8982
Practice Address - Street 1:1100 E. THIRD STREET
Practice Address - Street 2:SUITE G-102
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-778-8988
Practice Address - Fax:423-778-8982
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4247363AM0700X
TN1142363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical