Basic Information
| Provider Information | |||||||||
| NPI: | 1639668965 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKINNEY | ||||||||
| FirstName: | NATHAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9880 ANGIES WAY STE 250 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402412865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023946341 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2018 | ||||||||
| LastUpdateDate: | 09/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 02006869A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 05349 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RS0010X | 02006869A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RS0010X | 05349 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine |
No ID Information.