Provider Demographics
NPI:1629810312
Name:MCKIE, ALICIA AGNES
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:AGNES
Last Name:MCKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-3052
Mailing Address - Country:US
Mailing Address - Phone:407-557-4752
Mailing Address - Fax:
Practice Address - Street 1:524 MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-3052
Practice Address - Country:US
Practice Address - Phone:407-557-4752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator