Johnathan McKennis, CFSA

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

176541 Issued in TX

Practice address

1011 N Galloway Ave
Mesquite, TX 75149-2433

Phone

(214) 320-7000

NPI assigned

Jun 15, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715990400000",
    "number": "1265057376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850924",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751850924",
            "telephone_number": "601-214-4987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 N GALLOWAY AVE",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751492433",
            "telephone_number": "214-320-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1441 N Beckley Ave",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752031201",
            "country_code": "US",
            "telephone_number": "214-947-8181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKENNIS",
        "first_name": "JOHNATHAN",
        "credential": "CFSA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-15",
        "last_updated": "2024-05-18",
        "certification_date": "2024-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "TX",
            "license": "176541",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "176541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Michelle McDonald, D.C.
• Jason Sean McDonald, D.M.D.
• Breunna McGee, PT, DPT
• Erica McKee
• Miriam Simone McKennie
• Ciara C McKenzie
• Joyce McKinley
• Byron M McKnight II, D.D.S.
• Kiery Ann McMullen, FNP
• Stefanie McNeal, PT, DPT

• Obstetrics & Gynecology Physician in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Obstetrics & Gynecology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.