Basic Information
| Provider Information | |||||||||
| NPI: | 1083376594 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHRISTINA MCKINLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 211 CHURCHILL DOWNS DR | ||||||||
| Address2: | |||||||||
| City: | BUSH | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704314504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5042325695 | ||||||||
| FaxNumber: | 9857810548 | ||||||||
| Practice Location | |||||||||
| Address1: | 71107 HIGHWAY 21 | ||||||||
| Address2: | |||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704337243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9857810548 | ||||||||
| FaxNumber: | 9857814319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2021 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCKINLEY | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5042325695 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.