Individual
JOHNATHAN MCKENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CFSA
Contact information
Practice address
1011 N GALLOWAY AVE, MESQUITE, TX 75149-2433
(214) 320-7000
Mailing address
PO BOX 850924, MESQUITE, TX 75185-0924
(601) 214-4987
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
176541
TX
207VX0000X
Obstetrics Physician
176541
TX
Other
Enumeration date
06/15/2020
Last updated
05/18/2024
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