Provider Demographics
NPI:1770173676
Name:MCKINNON, SIERRA FAITH (MCP)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:FAITH
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:MCP
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:
Other - Last Name:GABLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-4527
Mailing Address - Country:US
Mailing Address - Phone:580-749-5056
Mailing Address - Fax:580-215-5765
Practice Address - Street 1:110 N 4TH ST
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-4527
Practice Address - Country:US
Practice Address - Phone:580-749-5056
Practice Address - Fax:580-215-5765
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator