Healthcare Provider Details

I. General information

NPI: 1093118150
Provider Name (Legal Business Name): DYNEIA MCKEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 05/25/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 W GAINES ST
MONTICELLO AR
71655-4637
US

IV. Provider business mailing address

602 N WALTON BLVD
BENTONVILLE AR
72712-4576
US

V. Phone/Fax

Practice location:
  • Phone: 479-464-1060
  • Fax: 479-271-6307
Mailing address:
  • Phone: 479-464-1060
  • Fax: 479-271-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: