Basic Information
| Provider Information | |||||||||
| NPI: | 1568677052 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCKEON | ||||||||
| FirstName: | TOSHIA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN, CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7940 SHOAL CREEK BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787577589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124944000 | ||||||||
| FaxNumber: | 5124944024 | ||||||||
| Practice Location | |||||||||
| Address1: | 7940 SHOAL CREEK BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787577589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124944000 | ||||||||
| FaxNumber: | 5124944024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0402X | 683647 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology with Special Qualifications in Child Neurology | 363LP0200X | 20061217 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.