Provider Demographics
NPI:1932629284
Name:MCKINLEY, MOIRA SHEA ALENE (CRNP)
Entity type:Individual
Prefix:
First Name:MOIRA
Middle Name:SHEA ALENE
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MOIRA
Other - Middle Name:SHEA ALENE
Other - Last Name:NESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:96 KISH RD
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17084-8943
Mailing Address - Country:US
Mailing Address - Phone:717-667-7720
Mailing Address - Fax:717-667-7249
Practice Address - Street 1:96 KISH RD
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17084-8943
Practice Address - Country:US
Practice Address - Phone:717-667-7720
Practice Address - Fax:717-667-7249
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017794363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103394430Medicaid