Provider Demographics
NPI: | 1639107873 |
---|---|
Name: | MCKEAN, CORI ANN BARRETT (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | CORI |
Middle Name: | ANN BARRETT |
Last Name: | MCKEAN |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3841 GREEN HILLS VILLAGE DR STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | NASHVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37215-2691 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3601 THE VANDERBILT CLINIC |
Practice Address - Street 2: | |
Practice Address - City: | NASHVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37232-2053 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-322-5000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-28 |
Last Update Date: | 2023-07-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 42988 | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 4200654 | Other | BC BS TN |
TN | 1507198 | Medicaid | |
NY | 02040320 | Medicaid | |
NY | 826671 | Other | EMPIRE BC.BS |
NY | 5185519 | Other | AETNA |
NY | 02040320 | Medicaid | |
NY | 5185519 | Other | AETNA |
NY | G17042 | Medicare UPIN |