Provider Demographics
NPI:1619510120
Name:MCFADDEN, KECIA
Entity Type:Individual
Prefix:
First Name:KECIA
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KECIA
Other - Middle Name:
Other - Last Name:GUFFIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:101 W 147TH ST APT 16A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-4339
Mailing Address - Country:US
Mailing Address - Phone:917-854-4721
Mailing Address - Fax:
Practice Address - Street 1:101 W 147TH ST APT 16A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-4339
Practice Address - Country:US
Practice Address - Phone:917-854-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion