Provider Demographics
NPI:1114547551
Name:MCKEE, KYLE (LVN)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:
Last Name:MCKEE
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 CAMINO DEL SOL
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-7347
Mailing Address - Country:US
Mailing Address - Phone:817-914-8853
Mailing Address - Fax:
Practice Address - Street 1:1184 CAMINO DEL SOL
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-7347
Practice Address - Country:US
Practice Address - Phone:817-914-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288772164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse