Provider Demographics
NPI:1417286493
Name:MCKEEVER, NICOLE A (BS)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:A
Last Name:MCKEEVER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-5250
Mailing Address - Country:US
Mailing Address - Phone:520-882-0090
Mailing Address - Fax:520-882-6821
Practice Address - Street 1:2430 E 6TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5250
Practice Address - Country:US
Practice Address - Phone:520-882-0090
Practice Address - Fax:520-882-6821
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst