Provider Demographics
NPI:1043481369
Name:BACIGALUPO, MARY ELIZABETH (RN, CCRN, ACNP, APRN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:BACIGALUPO
Suffix:
Gender:F
Credentials:RN, CCRN, ACNP, APRN
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:LOCKYEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, ACNP-BC, APRN
Mailing Address - Street 1:4220 HARDING PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2005
Mailing Address - Country:US
Mailing Address - Phone:615-222-4097
Mailing Address - Fax:615-222-3687
Practice Address - Street 1:4220 HARDING PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2005
Practice Address - Country:US
Practice Address - Phone:615-222-4097
Practice Address - Fax:615-222-3687
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5549P363LA2200X
TNAPN13258363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000562599OtherANTHEM BCBS
KY7100043830Medicaid
KY000000562599OtherANTHEM BCBS
KYP00702071Medicare PIN