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NPI Code Detail

MEDICARE: MARIAN MCKAY APRN, PMHNP, PMHCNS

MEDICARE: MARIAN MCKAY APRN, PMHNP, PMHCNS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner3003047KY
2364SP0807XChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist3003047KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659397453
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAN MCKAY APRN, PMHNP, PMHCNS
Provider Business Mailing Address
First Line : 5402 HUBBARDS CT
Second Line :
City : LOUISVILLE
State : KY
Zip : 40207-2130
Country : US
Telephone Number : 502-548-1677
Fax Number :
Provider Business Practice Location Address
First Line : 2301 GOLDSMITH LN
Second Line :
City : LOUISVILLE
State : KY
Zip : 40218-1018
Country : US
Telephone Number : 502-458-1171
Fax Number : 502-479-9868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 08/06/2019

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