Provider Demographics
NPI:1124789649
Name:MCKEEHAN, JULIE YOLANDA
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:YOLANDA
Last Name:MCKEEHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44444 BUENA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1440
Mailing Address - Country:US
Mailing Address - Phone:661-400-1052
Mailing Address - Fax:
Practice Address - Street 1:1331 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2942
Practice Address - Country:US
Practice Address - Phone:661-940-9094
Practice Address - Fax:661-951-1030
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program