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General NPI Number Information
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NPI Number | 1265916720
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Entity Type | Individual
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Provider Name | MRS. KIMBERLY MCKEAN
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Gender | Female
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Dates
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Enumeration Date | 09/20/2018
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 860 E RALPH HALL PKWY STE 21
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City | ROCKWALL
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State | TX
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Zip | 75032-6877
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Country | US
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Telephone | 847-337-7087
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 WALNUT ST
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City | COMMERCE
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State | TX
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Zip | 75428-3347
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Country | US
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Telephone | 847-337-7087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | 1767974
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License Number State | TX
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