Provider Demographics
NPI:1164245395
Name:MCKINNEY, KATHRYN ELLIOT (MSN, CNM, APRN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELLIOT
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:MSN, CNM, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-3708
Mailing Address - Country:US
Mailing Address - Phone:804-363-7422
Mailing Address - Fax:
Practice Address - Street 1:39 BEAM LN
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2348
Practice Address - Country:US
Practice Address - Phone:804-363-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24193205367A00000X, 367A00000X
VA0001258942163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk