Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 1109 | AK |
NPI | 1003143363 |
---|---|
Provider Name | Ms. Mary Kay Mccarty |
First Address | Portland, OR 97208-4105 |
Second Address | Anchorage, AK 99508-5931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2009 |
Last Update Date | 03/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1022294 | (05) | AK |