Provider Demographics
NPI:1962447045
Name:MCKAY, KELISIA BURKS (FNP)
Entity Type:Individual
Prefix:
First Name:KELISIA
Middle Name:BURKS
Last Name:MCKAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 AVENUE PALAIS ROYAL
Mailing Address - Street 2:P.O. BOX 3059
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6403
Mailing Address - Country:US
Mailing Address - Phone:985-809-7954
Mailing Address - Fax:
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2489
Practice Address - Country:US
Practice Address - Phone:504-412-1705
Practice Address - Fax:504-412-1702
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO4592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1528820Medicaid
LA3A367F669Medicare PIN
LA3A367Medicare PIN