Provider Demographics
NPI:1104126549
Name:MCKEE, LORI JEANNE (PA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JEANNE
Last Name:MCKEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 ALTAMESA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3524
Mailing Address - Country:US
Mailing Address - Phone:817-912-9000
Mailing Address - Fax:817-912-9010
Practice Address - Street 1:6420 ALTAMESA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3524
Practice Address - Country:US
Practice Address - Phone:817-912-9000
Practice Address - Fax:817-912-9010
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014328363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03303248Medicaid
NYJ400253828-GRP70008AMedicare PIN
NY03303248Medicaid