Provider Demographics
NPI:1265521280
Name:MCKEAN, ALLISON M (PA-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:MCKEAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2747 NE CONNERS AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8738
Mailing Address - Country:US
Mailing Address - Phone:541-382-5712
Mailing Address - Fax:
Practice Address - Street 1:2747 NE CONNERS AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8738
Practice Address - Country:US
Practice Address - Phone:541-382-5712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01042363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500605554Medicaid
ORQ00551Medicare UPIN
OR135922Medicare PIN