Provider Demographics
NPI:1003143363
Name:MCCARTY, MARY KAY (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAY
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4105
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4105
Mailing Address - Country:US
Mailing Address - Phone:866-907-1068
Mailing Address - Fax:425-917-9141
Practice Address - Street 1:3925 TUDOR CENTRE DR
Practice Address - Street 2:#100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5931
Practice Address - Country:US
Practice Address - Phone:907-561-8301
Practice Address - Fax:907-561-8170
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK1109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1022294Medicaid