Individual
MCKINLEY BOATNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1901 SPRINGLAKE DR, OKLAHOMA CITY, OK 73111-5201
(405) 521-8486
(405) 521-8496
Mailing address
PO BOX 30589, MIDWEST CITY, OK 73140-3589
(405) 769-3301
(405) 769-9685
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
578
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200013400A
—
OK
05
—
200013400B
—
OK
05
—
200013400C
—
OK
01
—
578
PA LICENSE
OK
Enumeration date
12/01/2005
Last updated
10/30/2019
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