Healthcare Provider Details

I. General information

NPI: 1841283959
Provider Name (Legal Business Name): KAY M NASH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAY M. CENTERS PA-C

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 BRUNSWICK ST
OLD TOWN ME
04468-1613
US

IV. Provider business mailing address

242 BRUNSWICK ST
OLD TOWN ME
04468-1613
US

V. Phone/Fax

Practice location:
  • Phone: 207-827-6128
  • Fax: 207-907-7079
Mailing address:
  • Phone: 207-827-6128
  • Fax: 207-907-7079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1339
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8401010
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: