Provider Demographics
NPI:1497213045
Name:MCKINNON, LISA MICHELLE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MICHELLE
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:CPNP
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Mailing Address - Street 1:2174 N DRUID HILLS RD NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3102
Mailing Address - Country:US
Mailing Address - Phone:404-784-0242
Mailing Address - Fax:404-785-3489
Practice Address - Street 1:2174 N DRUID HILLS RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3102
Practice Address - Country:US
Practice Address - Phone:404-785-9344
Practice Address - Fax:404-785-3489
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-02
Last Update Date:2025-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA1497213045363L00000X
GARN223686208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208000000XAllopathic & Osteopathic PhysiciansPediatrics