Individual
MRS. MARY JANE MCKINNIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
905 11TH ST, LAKE CHARLES, LA 70601-6230
(337) 433-7117
(337) 433-7117
Mailing address
905 11TH ST, LAKE CHARLES, LA 70601-6230
(337) 433-7117
(337) 433-7117
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
AP05000
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1409171
—
LA
Enumeration date
09/24/2006
Last updated
11/13/2008
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