Individual provider Active NPI

Beverly Sue McKean, REGISTERED NURSE

  • General Practice Registered Nurse
  • Holly Hill, FL
National Provider Identifier
1043596828
Registry record updated Oct 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice Registered NurseTaxonomy code 163WG0000X
License
RN9257416 Issued in FL
Practice address
809 Grove Ave
Holly Hill, FL 32117-3413
Phone
(386) 675-5274
NPI assigned
Oct 25, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 25, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X RN9257416 FL Primary

Addresses

Primary practice location

809 Grove Ave
Holly Hill, FL 32117-3413

Mailing address

809 Grove Ave
Holly Hill, FL 32117-3413
Phone (386) 675-5274

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
RN9257416FLMDGeneral Practice Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319500800000",
    "number": "1043596828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 GROVE AVE",
            "city": "HOLLY HILL",
            "state": "FL",
            "postal_code": "321173413",
            "telephone_number": "386-675-5274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 GROVE AVE",
            "city": "HOLLY HILL",
            "state": "FL",
            "postal_code": "321173413",
            "telephone_number": "386-675-5274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKEAN",
        "first_name": "BEVERLY",
        "middle_name": "SUE",
        "name_prefix": "Ms.",
        "credential": "REGISTERED NURSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-10-25",
        "last_updated": "2011-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "FL",
            "license": "RN9257416",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holly Hill, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.