Provider Demographics
NPI:1568677052
Name:MCKEON, TOSHIA MICHELLE (RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:TOSHIA
Middle Name:MICHELLE
Last Name:MCKEON
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
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Mailing Address - Street 1:7940 SHOAL CREEK BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7589
Mailing Address - Country:US
Mailing Address - Phone:512-494-4000
Mailing Address - Fax:512-494-4024
Practice Address - Street 1:7940 SHOAL CREEK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7589
Practice Address - Country:US
Practice Address - Phone:512-494-4000
Practice Address - Fax:512-494-4024
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6836472084N0402X
TX20061217363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219706301Medicaid
TX8L27092Medicare PIN