Provider Demographics
NPI:1760223168
Name:MCKINNEY, ASHLEY RENEE
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:RENEE
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 W NAPOLEON AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2482
Mailing Address - Country:US
Mailing Address - Phone:504-418-3565
Mailing Address - Fax:
Practice Address - Street 1:4621 W NAPOLEON AVE STE 207
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2482
Practice Address - Country:US
Practice Address - Phone:504-418-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA824948663Medicaid