Basic Information
Provider Information
NPI: 1104992056
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCKINNEY
FirstName: DEBBIE
MiddleName: LYNN
NamePrefix: MS.
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 895 STATE FARM RD
Address2: SUITE 508
City: BOONE
State: NC
PostalCode: 286074917
CountryCode: US
TelephoneNumber: 8282649007
FaxNumber: 8282625687
Practice Location
Address1: 360 BEECH STREET
Address2:  
City: NEWLAND
State: NC
PostalCode: 286570040
CountryCode: US
TelephoneNumber: 8287335889
FaxNumber: 8282625687
Other Information
ProviderEnumerationDate: 11/24/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X75790NCY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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