1497800254 NPI number — MRS. MARYE ANGELYN MCKENNEY RN, MSN, APRN

Table of content: MRS. MARYE ANGELYN MCKENNEY RN, MSN, APRN (NPI 1497800254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497800254 NPI number — MRS. MARYE ANGELYN MCKENNEY RN, MSN, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKENNEY
Provider First Name:
MARYE
Provider Middle Name:
ANGELYN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497800254
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 DARWISH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCDONOUGH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30252-3600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-957-8711
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3720 DAVINCI CT
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
NORCROSS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30092-7627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-300-3502
Provider Business Practice Location Address Fax Number:
770-582-4189
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  RN077182 NP , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LG0600X , with the licence number: RN077182 NP , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com