Healthcare Provider Details

I. General information

NPI: 1134692866
Provider Name (Legal Business Name): TRACY LYNN MCKAY SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3495 HOFFMAN ST
GREEN COVE SPRINGS FL
32043-4770
US

IV. Provider business mailing address

2757 SPINNERBAIT CT
ST AUGUSTINE FL
32092-2442
US

V. Phone/Fax

Practice location:
  • Phone: 904-400-7016
  • Fax:
Mailing address:
  • Phone: 904-501-5856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA8675
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: