Provider Demographics
NPI:1821743667
Name:MCKAY, KOBE
Entity Type:Individual
Prefix:
First Name:KOBE
Middle Name:
Last Name:MCKAY
Suffix:
Gender:M
Credentials:
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 123
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ND
Mailing Address - Zip Code:58338-0123
Mailing Address - Country:US
Mailing Address - Phone:701-381-9752
Mailing Address - Fax:
Practice Address - Street 1:305 2ND AVENUE S
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ND
Practice Address - Zip Code:58338-5833
Practice Address - Country:US
Practice Address - Phone:701-381-9752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant