Provider Demographics
NPI:1871557603
Name:MCKEE, JUDITH A (CRNA)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:MCKEE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CAPRI BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5661
Mailing Address - Country:US
Mailing Address - Phone:928-855-9477
Mailing Address - Fax:
Practice Address - Street 1:40 CAPRI BLVD
Practice Address - Street 2:STE 102
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5661
Practice Address - Country:US
Practice Address - Phone:928-855-9477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ012144367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ936643Medicaid
AZAZ0308020OtherBCBS AZ
AZP00292241Medicare PIN
AZ108075Medicare PIN
AZCS0262Medicare PIN
AZ936643Medicaid
AZZ108075Medicare PIN