Provider Demographics
NPI:1942088893
Name:MCKEE, JESSICA LYNN (RDH PHDH)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:MCKEE
Suffix:
Gender:F
Credentials:RDH PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 HIGHWAY 164 E
Mailing Address - Street 2:
Mailing Address - City:OQUAWKA
Mailing Address - State:IL
Mailing Address - Zip Code:61469-3204
Mailing Address - Country:US
Mailing Address - Phone:319-572-4036
Mailing Address - Fax:
Practice Address - Street 1:1204 HIGHWAY 164 E
Practice Address - Street 2:
Practice Address - City:OQUAWKA
Practice Address - State:IL
Practice Address - Zip Code:61469-3204
Practice Address - Country:US
Practice Address - Phone:309-867-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020013716124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist