Individual
MARILYN J MCKINNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2733
(682) 885-4054
(682) 885-7497
Mailing address
PO BOX 162835, FORT WORTH, TX 76161-2835
(817) 334-0530
(817) 334-0235
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
711625
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10017375
AMERIGROUP PIN
TX
05
—
137345809
—
TX
01
—
1447220850
GRP NPI NUMBER
—
05
—
170806701
—
TX
Enumeration date
12/12/2006
Last updated
05/04/2010
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