Healthcare Provider Details

I. General information

NPI: 1891539805
Provider Name (Legal Business Name): MARY MARGARET ELIZABETH MCCARTY B.A. ELEMENTARY ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3683 S FIRST ST
JENA LA
71342-6409
US

IV. Provider business mailing address

3683 S FIRST ST
JENA LA
71342-6409
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-2263
  • Fax: 318-992-2267
Mailing address:
  • Phone: 318-715-2646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: