Individual
KEITH VINCENT MCINNERNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
630 N KIMBALL AVE STE 100, SOUTHLAKE, TX 76092-6886
(817) 421-8777
Mailing address
630 N KIMBALL AVE STE 100, SOUTHLAKE, TX 76092-6886
(817) 421-8777
(817) 421-4388
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
2585
OK
363AM0700X
Medical Physician Assistant
Primary
PA09502
TX
Other
Enumeration date
12/12/2014
Last updated
03/10/2021
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