Active NPI
Teresa Louise McKetney, MD
- Family Medicine Physician
- Canton, MS
National Provider Identifier
1265589360
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 12137
- Practice address
- 1668 W Peace St
Canton, MS 39046-5332 - Phone
- (601) 859-5213
- Fax
- (601) 859-9477
- NPI assigned
- Jan 4, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 12137 | MS | Primary |
Addresses
Primary practice location
1668 W Peace St
Canton, MS 39046-5332
Mailing address
1668 W Peace St
PO Box 588
Canton, MS 39046-5332
Phone (601) 859-5213
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00117360 | Medicaid | MS |
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)
- Enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- teresa.mcketney.p1@direct.gacfhc.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506038400000",
"number": "1265589360",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1668 W PEACE ST",
"address_2": "PO BOX 588",
"city": "CANTON",
"state": "MS",
"postal_code": "390465332",
"telephone_number": "601-859-5213",
"fax_number": "601-859-9477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1668 W PEACE ST",
"city": "CANTON",
"state": "MS",
"postal_code": "390465332",
"telephone_number": "601-859-5213",
"fax_number": "601-859-9477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKETNEY",
"first_name": "TERESA",
"middle_name": "LOUISE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-04",
"last_updated": "2017-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MS",
"license": "12137",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00117360",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.