Provider Demographics
NPI:1730404492
Name:MCKEAN, KAREN JAYNE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:JAYNE
Last Name:MCKEAN
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 1:1808 BURLINGAME AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-1229
Mailing Address - Country:US
Mailing Address - Phone:616-247-8364
Mailing Address - Fax:
Practice Address - Street 1:277 NORTH ST
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1138
Practice Address - Country:US
Practice Address - Phone:269-673-5092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802061533171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator