MEDICARE: ASHLEY MCCAIN

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
1	164W00000X	Licensed Practical Nurse	PN.128922-M-IV	OH

General Provider Information

NPI Number	:	1811257967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MCCAIN

Provider Business Mailing Address
First Line	:	318 BOUNDARY ST
Second Line	:
City	:	OAK HILL
State	:	OH
Zip	:	45656-1112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	763 DEWEY EXTENSION RD
Second Line	:
City	:	LUCASVILLE
State	:	OH
Zip	:	45648-8763
Country	:	US
Telephone Number	:	740-820-2995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2012
Last Update Date	:	05/23/2012

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Directions to “ ASHLEY MCCAIN ” Practice Location

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