Provider Demographics
NPI:1144676875
Name:MCKEON, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCKEON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:HIGHMOUNT
Mailing Address - State:NY
Mailing Address - Zip Code:12441-0216
Mailing Address - Country:US
Mailing Address - Phone:845-254-5256
Mailing Address - Fax:
Practice Address - Street 1:74 ULSTER AND DELAWARE TURNPIKE
Practice Address - Street 2:
Practice Address - City:HIGHMOUNT
Practice Address - State:NY
Practice Address - Zip Code:12441
Practice Address - Country:US
Practice Address - Phone:845-254-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340490-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily