McKeeg Russell, CNA
Individual provider Active NPI Nurse's Aide · Moffat, CO
NPI 1306417399 · NPPES record last updated Jul 9, 2021
Key facts
- NPI
- 1306417399
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse's Aide 376K00000X
- License
- TNA00003041 (CO)
- Practice address
- 26045 Woodard Ave
Moffat, CO 81143-9782 - Phone
- (719) 221-6224
- NPI assigned
- Jul 9, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TNA00003041 | CO | MD | Nurse's Aide |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | TNA00003041 | CO | Yes |
Addresses
Primary practice location
26045 Woodard Ave
Moffat, CO 81143-9782
Mailing address
26045 Woodard Ave
Moffat, CO 81143-9782
Phone (719) 221-6224
Other providers in Moffat, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.