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General NPI Number Information
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NPI Number | 1497649917
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Entity Type | Individual
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Provider Name | MAKENSEE CORRIVEAU APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 68 E ELKINS ST
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City | STANTON
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State | KY
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Zip | 40380-2311
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Country | US
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Telephone | 859-404-7686
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Fax |
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Provider Business Mailing Address
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Address Line | 3453 ALDERSHOT DR
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City | LEXINGTON
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State | KY
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Zip | 40503-4201
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Country | US
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Telephone | 859-333-3925
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4041607
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License Number State | KY
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