Basic Information
Provider Information
NPI: 1558778712
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCKEE
FirstName: KERRI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 421
Address2:  
City: LIBERTY LAKE
State: WA
PostalCode: 990190421
CountryCode: US
TelephoneNumber: 8667472455
FaxNumber: 5092277070
Practice Location
Address1: 16528 E DESMET CT
Address2:  
City: SPOKANE VALLEY
State: WA
PostalCode: 992163522
CountryCode: US
TelephoneNumber: 5099448920
FaxNumber: 5092277070
Other Information
ProviderEnumerationDate: 07/18/2014
LastUpdateDate: 09/24/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/24/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700XPA.0003942CON Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
363AM0700XPA61035763WAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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