MEDICARE: CAROL MCMAHAN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0400X	Rehabilitation Registered Nurse	1108604	KY

General Provider Information

NPI Number	:	1184291981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL MCMAHAN RN

Provider Business Mailing Address
First Line	:	4308 DAWKINS CT
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40229-2010
Country	:	US
Telephone Number	:	502-876-7122
Fax Number	:

Provider Business Practice Location Address
First Line	:	3625 FERN VALLEY RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40219-1916
Country	:	US
Telephone Number	:	502-785-8558
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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