Individual
PRISCILLA LYNN MCKINNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
511 CYPRESS DR, RAEFORD, NC 28376-5323
(910) 978-5706
Mailing address
1716 SHAW RD, FAYETTEVILLE, NC 28311-2243
(910) 978-5706
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3747A0650X
VETERAN
NC
Enumeration date
11/06/2019
Last updated
11/06/2019
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