Provider Demographics
NPI:1427653047
Name:MCFADDEN, KAILEE
Entity type:Individual
Prefix:
First Name:KAILEE
Middle Name:
Last Name:MCFADDEN
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 1:674 DENALI DR
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:SD
Mailing Address - Zip Code:57719-8510
Mailing Address - Country:US
Mailing Address - Phone:402-570-9986
Mailing Address - Fax:
Practice Address - Street 1:674 DENALI DR
Practice Address - Street 2:
Practice Address - City:BOX ELDER
Practice Address - State:SD
Practice Address - Zip Code:57719-8510
Practice Address - Country:US
Practice Address - Phone:402-570-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD3747A0650XOtherN/A