Individual
SUSAN A. MCKINNEY
Active
Individual
SUSAN A. MCKINNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10000139A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000506703
BC/BS PIN
IN
01
—
200856130
MEDICAID GROUP
IN
01
—
DF5450
RAILROAD GROUP
IN
01
—
P00383030
RAILROAD MEDICARE PIN
—
Enumeration date
05/19/2006
Last updated
07/26/2011
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