Provider Demographics
NPI:1053154740
Name:MCKINNEY, LAVONA DION (NP)
Entity type:Individual
Prefix:MRS
First Name:LAVONA
Middle Name:DION
Last Name:MCKINNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 VENUS ST
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-3722
Mailing Address - Country:US
Mailing Address - Phone:803-899-2102
Mailing Address - Fax:
Practice Address - Street 1:212 S HAYNE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5503
Practice Address - Country:US
Practice Address - Phone:704-635-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF06241481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily