Individual
VICKI A MCKINNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
50 N MEDICAL DR, SALT LAKE CITY, UT 84132-0001
(801) 581-2121
Mailing address
PO BOX 581700, SALT LAKE CITY, UT 84158-1700
(801) 581-2121
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
101984-1206
UT
363AM0700X
Medical Physician Assistant
101984-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0437294
—
MT
01
—
369
UNIVERSITY HEALTH PLANS #
—
01
—
51202
PEHP #
—
05
—
806030900
—
ID
01
—
970019921
MEDICARE RAILROAD #
—
01
—
QM0000037455
ALTIUS #
—
Enumeration date
05/12/2006
Last updated
07/30/2012
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