Provider Demographics
NPI:1245600659
Name:MCKAY, KRISTERNE ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:KRISTERNE
Middle Name:ANN
Last Name:MCKAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTERNE
Other - Middle Name:ANN
Other - Last Name:CAREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1515 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203
Mailing Address - Country:US
Mailing Address - Phone:517-787-5710
Mailing Address - Fax:517-787-9855
Practice Address - Street 1:1515 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203
Practice Address - Country:US
Practice Address - Phone:517-787-5710
Practice Address - Fax:517-787-9855
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704178204163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse