Provider Demographics
NPI:1285983809
Name:MCKEOUGH, JULIE (LVN)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MCKEOUGH
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 W BARSTOW AVE
Mailing Address - Street 2:APT 229
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1549
Mailing Address - Country:US
Mailing Address - Phone:559-270-9381
Mailing Address - Fax:
Practice Address - Street 1:647 W BARSTOW AVE
Practice Address - Street 2:APT 229
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1549
Practice Address - Country:US
Practice Address - Phone:559-270-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 265376164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse