MEDICARE: CHARLEEN TRIANDA MCKEY

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	3747P1801X	Personal Care Attendant		LA

General Provider Information

NPI Number	:	1568028165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLEEN TRIANDA MCKEY

Provider Business Mailing Address
First Line	:	11822 JUSTICE AVE STE B5
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2306
Country	:	US
Telephone Number	:	504-215-9965
Fax Number	:	225-465-3984

Provider Business Practice Location Address
First Line	:	11822 JUSTICE AVE STE B5
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-2306
Country	:	US
Telephone Number	:	504-215-9965
Fax Number	:	225-465-3984

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

Provider Enumeration Date	:	05/20/2019
Last Update Date	:	05/20/2019

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Directions to “ CHARLEEN TRIANDA MCKEY ” Practice Location

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