Basic Information
Provider Information
NPI: 1790242519
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCKEE
FirstName: JULIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: MCKEE
OtherFirstName: JULIA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 5
Mailing Information
Address1: 6036 S JAMAICA ST
Address2:  
City: MURRAY
State: UT
PostalCode: 841236824
CountryCode: US
TelephoneNumber: 7608466810
FaxNumber:  
Practice Location
Address1: 515 E 700 S UNIT 2A
Address2:  
City: SALT LAKE CITY
State: UT
PostalCode: 841023307
CountryCode: US
TelephoneNumber: 8004348923
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/28/2019
LastUpdateDate: 02/28/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106S00000X  Y    

No ID Information.


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