Healthcare Provider Details

I. General information

NPI: 1740448299
Provider Name (Legal Business Name): JANAY MCKIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SAMFORD AVE
SHREVEPORT LA
71103-4239
US

IV. Provider business mailing address

PO BOX 8500 LOCK BOX 7642
PHILADELPHIA PA
19178-7642
US

V. Phone/Fax

Practice location:
  • Phone: 318-226-3306
  • Fax: 318-226-3319
Mailing address:
  • Phone: 813-821-8478
  • Fax: 813-281-8113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberP5290
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberMD.207313
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: