Provider Demographics
NPI:1356304414
Name:MCKEON, KIMBERLEY E (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:E
Last Name:MCKEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:E
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4951 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047
Mailing Address - Country:US
Mailing Address - Phone:785-832-2865
Mailing Address - Fax:785-841-3129
Practice Address - Street 1:4951 W 18TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047
Practice Address - Country:US
Practice Address - Phone:785-841-6540
Practice Address - Fax:785-841-3305
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS430950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200303010AMedicaid
KS200303010AMedicaid
KS104294Medicare ID - Type Unspecified