Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 280 | KY |
NPI | 1063410231 |
---|---|
Provider Name | Dr. Russell Lynn Mckinley |
First Address | Elizabethtown, KY 42702-6188 |
Second Address | Elizabethtown, KY 42701-3819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 21/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000300214 | ANTHEM (01) | KY |
50002169 | PASSPORT (01) | KY |
618577 | WELLCARE MEDICAID (01) | KY |
80000383 | (05) | KY |
P00068624 | RAILROAD MEDICARE (01) | KY |
U95884 | (02) | KY |