Provider Demographics
NPI:1881827756
Name:MCKEAN, JIMMIE D (LPO-CP)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:D
Last Name:MCKEAN
Suffix:
Gender:M
Credentials:LPO-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5222 BURNET RD STE 400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-2432
Mailing Address - Country:US
Mailing Address - Phone:512-302-4838
Mailing Address - Fax:
Practice Address - Street 1:5222 BURNET RD STE 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-2432
Practice Address - Country:US
Practice Address - Phone:512-302-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist