Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 0430298 | KS |
NPI | 1013099456 |
---|---|
Provider Name | Dr. Camille Aletha Russell Mckesey |
First Address | El Dorado, KS 67042 |
Second Address | El Dorado, KS 67042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103157 | BCBS OF KS (01) | KS |
453460 | FIRST GUARD (01) | KS |
H73947 | (02) |