Provider Demographics
NPI:1568028165
Name:MCKEY, CHARLEEN TRIANDA
Entity type:Individual
Prefix:
First Name:CHARLEEN
Middle Name:TRIANDA
Last Name:MCKEY
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 1:11822 JUSTICE AVE STE B5
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2306
Mailing Address - Country:US
Mailing Address - Phone:504-215-9965
Mailing Address - Fax:225-465-3984
Practice Address - Street 1:11822 JUSTICE AVE STE B5
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2306
Practice Address - Country:US
Practice Address - Phone:504-215-9965
Practice Address - Fax:225-465-3984
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant