Provider Demographics
NPI:1730188863
Name:MCKEE, KRISTI D (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:D
Last Name:MCKEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:DIANNE
Other - Last Name:WADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 5038
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-5038
Mailing Address - Country:US
Mailing Address - Phone:580-548-1367
Mailing Address - Fax:580-548-1537
Practice Address - Street 1:1805 W GARRIOTT RD
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5526
Practice Address - Country:US
Practice Address - Phone:580-233-9012
Practice Address - Fax:580-249-4269
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA778363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200008710AMedicaid
OK241412805Medicare PIN
OK200008710AMedicaid
S57148Medicare UPIN
OKOK403068Medicare PIN