Provider Demographics
NPI:1508341454
Name:MCKEE, LESLIE ELLEN (NP)
Entity Type:Individual
Prefix:MISS
First Name:LESLIE
Middle Name:ELLEN
Last Name:MCKEE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 E BANNER GATEWAY DR APT 3009
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4757
Mailing Address - Country:US
Mailing Address - Phone:810-488-0925
Mailing Address - Fax:
Practice Address - Street 1:4510 E BANNER GATEWAY DR APT 3009
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4757
Practice Address - Country:US
Practice Address - Phone:810-488-0925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN183238163WM0705X
AZ229403363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical