MEDICARE: MRS. MARY CATHERINE MCCARTHY RN, MSN,APRN, FNP

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	163W00000X	Registered Nurse	13-96207-102	KS
2	163W00000X	Registered Nurse	2007024272	MO
3	363LF0000X	Family Nurse Practitioner	53-74977-102	KS
4	363LF0000X	Family Nurse Practitioner	2009033161	MO

General Provider Information

NPI Number	:	1417286840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY CATHERINE MCCARTHY RN, MSN,APRN, FNP

Provider Business Mailing Address
First Line	:	2401 GILLHAM RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-4619
Country	:	US
Telephone Number	:	816-234-3564
Fax Number	:	816-460-1083

Provider Business Practice Location Address
First Line	:	4000 CAMBRIDGE ST
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66160-4619
Country	:	US
Telephone Number	:	931-588-4778
Fax Number	:

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

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	06/22/2020

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