Provider Demographics
NPI:1013273812
Name:MCFEE, KELLY DAWN (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DAWN
Last Name:MCFEE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:DAWN
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:137 N BELT HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3491
Mailing Address - Country:US
Mailing Address - Phone:816-271-7098
Mailing Address - Fax:
Practice Address - Street 1:137 N BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3491
Practice Address - Country:US
Practice Address - Phone:816-271-7098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012010645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1013273812Medicaid
MOP01129568OtherRR MEDICARE
KS200879940AMedicaid
MO701000170Medicare PIN