=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245100742
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIAH D MCCAFFERTY FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2025
-----------------------------------------------------
Last Update Date | 01/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 W MONROE ST STE 28
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60661-3777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-751-5783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 288
-----------------------------------------------------
City | SUMMERTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38483-0288
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-477-5097
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | NA
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------