Provider Demographics
NPI:1407891716
Name:MCKAY, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MCKAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:1325 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-322-7905
Practice Address - Fax:605-322-8414
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5189208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6004563Medicaid
IA1566000Medicaid
SD5189OtherDAKOTACARE
SD0041603OtherSD BLUE CROSS
MN200960900Medicaid
MN164K0MCOtherMN BLUE CROSS BS
NE46022474331Medicaid
SD6004564Medicaid
SDP00068515OtherRR MEDICARE
SD6004562Medicaid
SDS100787Medicare PIN
SDS106088Medicare PIN
NE46022474331Medicaid
SDCE0909Medicare PIN
MN200960900Medicaid
IA1566000Medicaid
SDP00068515Medicare PIN