Provider Demographics
NPI:1528838513
Name:MCKINNEY, JOHN TROY (BARBER STYLIST)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:TROY
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:BARBER STYLIST
Other - Prefix:
Other - First Name:BARBER
Other - Middle Name:
Other - Last Name:EDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BARBER EDGE
Mailing Address - Street 1:1208 E GREEN DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-6866
Mailing Address - Country:US
Mailing Address - Phone:601-738-0917
Mailing Address - Fax:
Practice Address - Street 1:1208 E GREEN DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-6866
Practice Address - Country:US
Practice Address - Phone:601-738-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36820374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician