Provider Demographics
NPI:1043279482
Name:MCKEE, NICOLE W (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:W
Last Name:MCKEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4423
Mailing Address - Country:US
Mailing Address - Phone:985-868-7882
Mailing Address - Fax:985-876-1700
Practice Address - Street 1:291 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4423
Practice Address - Country:US
Practice Address - Phone:985-868-7882
Practice Address - Fax:985-876-1700
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15069R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1127957Medicaid
LAH87919Medicare UPIN
LA1127957Medicaid