Healthcare Provider Details

I. General information

NPI: 1043977861
Provider Name (Legal Business Name): DEVIN SKYLAR MCCARTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 ALEXANDRIA PIKE
COLD SPRING KY
41076-2027
US

IV. Provider business mailing address

2139 AUBURN AVENUE ATTN: PAYOR ENROLLMENT 4-7
CINCINNATI OH
45219
US

V. Phone/Fax

Practice location:
  • Phone: 859-442-8700
  • Fax: 859-442-8718
Mailing address:
  • Phone: 513-351-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4007264
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: