Healthcare Provider Details

I. General information

NPI: 1669595369
Provider Name (Legal Business Name): MICHAEL A MCKAY MSN, CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMBALL STREET- OPD CLINIC MAINE MEDICAL CENTER
PORTLAND ME
04102
US

IV. Provider business mailing address

22 BRAMHALL STREET MAINE MEDICAL CENTER - OUTPATIENT CLINIC
PORTLAND ME
04102
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-2911
  • Fax:
Mailing address:
  • Phone: 207-662-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP081897
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: