Provider Demographics
NPI:1255736195
Name:MCKINNEY, ERIKA LYNNE (EDD, LAT, ATC, CHES)
Entity type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:LYNNE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:EDD, LAT, ATC, CHES
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:LYNNE
Other - Last Name:KASTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAT, ATC
Mailing Address - Street 1:429 CENTURY OAK DR
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2545
Mailing Address - Country:US
Mailing Address - Phone:419-618-6018
Mailing Address - Fax:
Practice Address - Street 1:100 N EAST AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-3103
Practice Address - Country:US
Practice Address - Phone:419-618-6018
Practice Address - Fax:262-524-7690
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2024-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0015372255A2300X
WI3175-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer