Provider Demographics
NPI:1669681771
Name:MCKEE, BARRY LYNN (PA C)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:LYNN
Last Name:MCKEE
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844665
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4665
Mailing Address - Country:US
Mailing Address - Phone:903-342-5227
Mailing Address - Fax:
Practice Address - Street 1:719 W COKE RD STE 4
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3060
Practice Address - Country:US
Practice Address - Phone:903-342-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-028OtherTRICARE
TX75-2616977-001OtherTRICARE
TX75-2771569-005OtherTRICARE
TX75-2616977-002OtherTRICARE
TX865N63OtherBCBS
TXP01304445OtherRAIL ROAD
TXP01304445OtherRAIL ROAD
TX75-2771569-005OtherTRICARE
TX865N63OtherBCBS
TX317807YMAFMedicare PIN