MEDICARE: CAROLINE GRAY MCKEE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9119735	FL

General Provider Information

NPI Number	:	1073393971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE GRAY MCKEE

Provider Business Mailing Address
First Line	:	PO BOX 746647
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6647
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	904-376-4075

Provider Business Practice Location Address
First Line	:	1348 S 18TH ST STE 200
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4785
Country	:	US
Telephone Number	:	904-202-6683
Fax Number	:	904-376-3062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	03/04/2026

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Directions to “ CAROLINE GRAY MCKEE ” Practice Location

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