Debra K McKinnon, DO

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

O-126 Issued in ID

Practice address

700 S Main St
Moscow, ID 83843-3056

Phone

(208) 882-4511

Fax

(208) 883-6580

NPI assigned

Jan 3, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1407903669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9899",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838431800",
            "telephone_number": "208-875-1567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S MAIN ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838433056",
            "telephone_number": "208-882-4511",
            "fax_number": "208-883-6580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNON",
        "first_name": "DEBRA",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "ID",
            "license": "O-126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BS ID",
            "identifier": "000010003680",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ID",
            "identifier": "B1717",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8144412",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caysie McGinness
• Korbyn Joseph McGreevy
• Anna McHugh
• Lauri McKean, LAC
• James Edward McKenzie, DC
• Brian William McNeill, PHD
• Mitchell McTier
• Ketha Mead
• Rechelle Ann Meade
• Rylee Jade Meagher

• Emergency Medical Services (Emergency Medicine) Physician in Moscow, ID
• Providers in Moscow, ID by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.