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Individual

JODI MCKEOWN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1001 POTRERO AVE, SAN FRANCISCO, CA 94110-3518
(415) 206-8303
Mailing address
3620 19TH ST APT 1, SAN FRANCISCO, CA 94110-6712
(808) 561-1856
(415) 206-4562

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
14883
CA
363AM0700X
Medical Physician Assistant
Primary
AMD-154
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
574279
HI
Enumeration date
03/03/2006
Last updated
05/03/2012
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