Provider Demographics
NPI:1154069961
Name:MCCARTY, REBECCA JEAN
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 LEXINGTON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444-2073
Mailing Address - Country:US
Mailing Address - Phone:859-302-0229
Mailing Address - Fax:
Practice Address - Street 1:102 RIVER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:KY
Practice Address - Zip Code:40336-1118
Practice Address - Country:US
Practice Address - Phone:606-614-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker