Provider Demographics
NPI:1811978653
Name:MCKENNEY, SUSAN CHRISTOS (FNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CHRISTOS
Last Name:MCKENNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27877
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0877
Mailing Address - Country:US
Mailing Address - Phone:919-966-8279
Mailing Address - Fax:
Practice Address - Street 1:712 FLEMING ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3502
Practice Address - Country:US
Practice Address - Phone:828-694-7630
Practice Address - Fax:828-694-7631
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-00028363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS66124OtherMEDICARE/UNITED GOVT SERV
NC2592348BOtherMEDICARE PTAN
NC560794933OtherTAX ID #