Provider Information for 1184020273
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BENNISHA MCKINNEY
Sex: Female
NPI: 1184020273
Last Updated: 2014-11-17
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1184020273 | ||||||||
| Enumeration Date | 2014-11-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 4171 N CROSSOVER RD FAYETTEVILLE, AR 72703-4591 United States Phone: 479-521-1427 | Fax:479-521-6520 | ||||||||
| Primary Practice Address | 815 FORT ST STE A BARLING, AR 72923-2180 United States Phone: 479-494-5700 | Fax:479-484-8142 | ||||||||
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