Provider Demographics
NPI:1316276322
Name:MCKINNEY, MEGAN L (MS PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 BETHEL RD
Mailing Address - Street 2:C/O JERSEY UROLOGY GROUP P. A.
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2188
Mailing Address - Country:US
Mailing Address - Phone:609-927-8746
Mailing Address - Fax:609-601-1406
Practice Address - Street 1:403 BETHEL RD
Practice Address - Street 2:C/O JERSEY UROLOGY GROUP P. A.
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2188
Practice Address - Country:US
Practice Address - Phone:609-927-8746
Practice Address - Fax:609-601-1406
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00231300363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MP00231300OtherLICENSE