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1003310590 NPI number — DALE-MARIE NEKEISHA MCKIE DO

NPI Number: 1003310590
Health Care Provider/Practitioner: DALE-MARIE NEKEISHA MCKIE DO

Information about “1003310590” NPI (DALE-MARIE NEKEISHA MCKIE DO) exists in 1003310590 in HTML format HTML  |  1003310590 in plain Text format TXT  |  1003310590 in PDF (Portable Document Format) PDF  |  1003310590 in an XML format XML  formats.

NPI Number : 1003310590 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1003310590",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCKIE",
    "FirstName": "DALE-MARIE",
    "MiddleName": "NEKEISHA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SIMPSON",
    "OtherFirstName": "DALE-MARIE",
    "OtherMiddleName": "NEKEISHA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "DO",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1395 NW 167TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIAMI GARDENS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33169-5710",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-473-3969",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5516 VIRGINIA BEACH BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VIRGINIA BEACH",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23462-5629",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-473-3969",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/20/2018",
    "LastUpdateDate": "11/07/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207Q00000X",
        "TaxonomyName": "Family Medicine Physician",
        "LicenseNumber": "0102206639",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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