MEDICARE: PHYLLIS MCCARTHY CIHC

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1518400753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS MCCARTHY CIHC

Provider Business Mailing Address
First Line	:	129 BASSWOOD CIR
Second Line	:
City	:	FT WRIGHT
State	:	KY
Zip	:	41011-3772
Country	:	US
Telephone Number	:	859-250-8367
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 BASSWOOD CIR
Second Line	:
City	:	FT WRIGHT
State	:	KY
Zip	:	41011-3772
Country	:	US
Telephone Number	:	859-250-8367
Fax Number	:

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

Provider Enumeration Date	:	11/21/2016
Last Update Date	:	11/21/2016

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