Provider Demographics
NPI:1013099456
Name:RUSSELL MCKESEY, CAMILLE ALETHA (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:ALETHA
Last Name:RUSSELL MCKESEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W CENTRAL
Mailing Address - Street 2:#204
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042
Mailing Address - Country:US
Mailing Address - Phone:316-320-0501
Mailing Address - Fax:316-321-0503
Practice Address - Street 1:700 W CENTRAL
Practice Address - Street 2:SUITE 204
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042
Practice Address - Country:US
Practice Address - Phone:316-320-0501
Practice Address - Fax:316-321-0503
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430298207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS453460OtherFIRST GUARD
KS103157OtherBCBS OF KS
H73947Medicare UPIN
KS103157Medicare ID - Type Unspecified