Healthcare Provider Details

I. General information

NPI: 1497649917
Provider Name (Legal Business Name): MAKENSEE CORRIVEAU APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 E ELKINS ST
STANTON KY
40380-2311
US

IV. Provider business mailing address

3453 ALDERSHOT DR
LEXINGTON KY
40503-4201
US

V. Phone/Fax

Practice location:
  • Phone: 859-404-7686
  • Fax:
Mailing address:
  • Phone: 859-333-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4041607
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: