Individual
THOMAS GORDON MCKENNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1600 NORTH SECOND ST, CLINTON, MO 64735-1192
(660) 890-7103
(660) 885-8496
Mailing address
69 NE 100, CLINTON, MO 64735
(660) 885-8858
(660) 885-8496
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
073437
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
912688322
—
MO
Enumeration date
11/09/2006
Last updated
03/04/2010
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