Provider Demographics
NPI:1972767267
Name:MCKINLEY, BRIAN WAYNE (ACNP-BC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:WAYNE
Last Name:MCKINLEY
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5618 BRAINERD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5310
Mailing Address - Country:US
Mailing Address - Phone:865-558-3476
Mailing Address - Fax:865-330-6323
Practice Address - Street 1:1326 PAPERMILL POINTE WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1903
Practice Address - Country:US
Practice Address - Phone:865-558-3476
Practice Address - Fax:865-330-6323
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13399363LA2100X
TNAPN13399207P00000X
GARN246719363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine