Provider Demographics
NPI:1700108651
Name:MCKEOWN, ALEXIS A (DPM)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:A
Last Name:MCKEOWN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ALASKAN WAY 526
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1078
Mailing Address - Country:US
Mailing Address - Phone:404-210-5620
Mailing Address - Fax:
Practice Address - Street 1:1950 ALASKAN WAY 526
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1078
Practice Address - Country:US
Practice Address - Phone:404-210-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60295566213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01099024OtherRAILROAD MEDICARE PTAN
P01099024OtherRAILROAD MEDICARE PTAN