Provider Demographics
NPI:1831274133
Name:MCKEON, KATHLEEN (ARNP, CNM)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MCKEON
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HODGES DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4614
Mailing Address - Country:US
Mailing Address - Phone:850-431-5714
Mailing Address - Fax:850-431-6403
Practice Address - Street 1:1304 HODGES DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4613
Practice Address - Country:US
Practice Address - Phone:850-431-4500
Practice Address - Fax:850-216-1037
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9211515367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife