Provider Demographics
NPI:1366258659
Name:MCKEEHAN, JULIA ANGELINA (AGNP-C)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ANGELINA
Last Name:MCKEEHAN
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 11TH AVE UNIT 2105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7895
Mailing Address - Country:US
Mailing Address - Phone:480-326-9192
Mailing Address - Fax:
Practice Address - Street 1:100 WASHINGTON AVE S STE 1210
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55401-2511
Practice Address - Country:US
Practice Address - Phone:180-092-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033208363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care