Provider Demographics
NPI:1760661847
Name:MCKINNEY, JAMIE
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
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 1:314 PERSIMMON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5010
Mailing Address - Country:US
Mailing Address - Phone:502-435-2956
Mailing Address - Fax:502-237-8772
Practice Address - Street 1:314 PERSIMMON RIDGE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5010
Practice Address - Country:US
Practice Address - Phone:502-435-2956
Practice Address - Fax:502-237-8772
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2020-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist