Healthcare Provider Details

I. General information

NPI: 1144719493
Provider Name (Legal Business Name): JEFFREY D MCCARTY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4835 POPLAR LEVEL RD STE 110
LOUISVILLE KY
40213-2906
US

IV. Provider business mailing address

7400 PAIUTE RD
LOUISVILLE KY
40214-4114
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax: 502-631-9660
Mailing address:
  • Phone: 502-762-5949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1125995
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: