MEDICARE: BRENT JAMISON MCKECUEN

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	343900000X	Non-emergency Medical Transport (VAN)		NC
2	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1285416206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT JAMISON MCKECUEN

Provider Business Mailing Address
First Line	:	112 DANCES BAY RD
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-9172
Country	:	US
Telephone Number	:	252-339-1922
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 S HUGHES BLVD
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-4526
Country	:	US
Telephone Number	:	252-339-1922
Fax Number	:

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

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	05/21/2024

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Directions to “ BRENT JAMISON MCKECUEN ” Practice Location

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