1396927174 NPI number — MISS KEECHA NICOLE MC KINNON MSW

Table of content: MISS KEECHA NICOLE MC KINNON MSW (NPI 1396927174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396927174 NPI number — MISS KEECHA NICOLE MC KINNON MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MC KINNON
Provider First Name:
KEECHA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396927174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17290 HIGHLAND AVE
Provider Second Line Business Mailing Address:
APT 3K
Provider Business Mailing Address City Name:
JAMAICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11432-2869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-400-1871
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17290 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
APT 3K
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-2869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-400-1871
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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