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General NPI Number Information
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NPI Number | 1316338593
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Entity Type | Individual
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Provider Name | MANDY JO MCCARTY NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 03/11/2024
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Provider Practice Location Address
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Address Line | 2000 S MAIN ST
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City | FAIRFIELD
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State | IA
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Zip | 52556-9572
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Country | US
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Telephone | 641-472-9111
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Fax |
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Provider Business Mailing Address
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Address Line | 20937 RUSSELL CORNER RD
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City | GRAVETTE
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State | AR
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Zip | 72736-8953
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Country | US
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Telephone | 479-787-8034
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A004296
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License Number State | AR
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