Provider Demographics
NPI:1629149992
Name:MCKEE, LAURIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:MCKEE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2519
Mailing Address - Country:US
Mailing Address - Phone:904-241-5229
Mailing Address - Fax:904-384-3453
Practice Address - Street 1:4282 HERSCHEL ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-2247
Practice Address - Country:US
Practice Address - Phone:904-384-3453
Practice Address - Fax:904-384-3453
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-20053174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16559OtherMM LICENSE NUMBER
FL20053OtherMA LICENSE NUMBER