Provider Demographics
NPI:1073867438
Name:MCCAULEY, MARIA T (APRN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:T
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9520 ORMSBY STATION RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5017
Practice Address - Country:US
Practice Address - Phone:502-426-0606
Practice Address - Fax:502-454-0591
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007723363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100227530Medicaid
KYK074923Medicare PIN
KYK074920Medicare PIN
KYK074928Medicare PIN
KYK074922Medicare PIN
KY7100227530Medicaid
KYK074925Medicare PIN
KYK074921Medicare PIN
KYK074924Medicare PIN