Doctor Name: | KELLY MAE MCCARTHY |
NPI Number: | 1013288448 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 28176558A |
Business Practice Address: | 100 Navarre Pl Suite 6600 South Bend, IN - 466011156 |
Business Phone Number: | 5742327227 |
Business Fax Number: | 5742322064 |
Mailing Address: | 710 N Niles Ave, SOUTH BEND |
State: | IN |
Postal Code: | 466171924 |
Phone Number: | 5746471610 |
Fax Number: | |
NPI Enumeration Date: | 01/17/2012 |
NPI Last Update Date: | 03/21/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 28176558A |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |