Provider Demographics
NPI:1982955852
Name:MCKEAN, AMANDA JO
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JO
Last Name:MCKEAN
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 1:120 DEER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-9546
Mailing Address - Country:US
Mailing Address - Phone:216-618-3080
Mailing Address - Fax:
Practice Address - Street 1:120 DEER RIDGE DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-9546
Practice Address - Country:US
Practice Address - Phone:216-618-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR193186783Medicare PIN