Provider Demographics
NPI:1447937271
Name:MCKENNY, CINDY
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:MCKENNY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1609 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3649
Mailing Address - Country:US
Mailing Address - Phone:601-291-4719
Mailing Address - Fax:
Practice Address - Street 1:811 FOLEY ST STE K
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-3433
Practice Address - Country:US
Practice Address - Phone:769-333-5442
Practice Address - Fax:769-257-7998
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide