Individual
JONATHAN LUCERO MCKINNEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
825 CHALKSTONE AVE, PROVIDENCE, RI 02908-4728
(401) 456-2000
Mailing address
40 PRINCETON AVE, PROVIDENCE, RI 02907-4115
(717) 673-7066
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01489
RI
Other
Enumeration date
06/20/2022
Last updated
03/26/2024
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