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General NPI Number Information
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NPI Number | 1962447045
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Entity Type | Individual
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Provider Name | KELISIA BURKS MCKAY FNP
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Gender | Female
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 01/22/2009
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Provider Practice Location Address
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Address Line | 200 W ESPLANADE AVE SUITE 205
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City | KENNER
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State | LA
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Zip | 70065-2489
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Country | US
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Telephone | 504-412-1705
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Fax | 504-412-1702
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Provider Business Mailing Address
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Address Line | 423 AVENUE PALAIS ROYAL P.O. BOX 3059
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City | COVINGTON
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State | LA
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Zip | 70433-6403
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Country | US
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Telephone | 985-809-7954
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APO4592
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License Number State | LA
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