Provider Demographics
NPI:1306217120
Name:MCNAMARA, VALERIE DANIELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:DANIELLE
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:DANIELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:100 KIANA CT APT B
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-6767
Mailing Address - Country:US
Mailing Address - Phone:270-408-6100
Mailing Address - Fax:270-408-6112
Practice Address - Street 1:100 KIANA CT APT B
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6767
Practice Address - Country:US
Practice Address - Phone:270-408-6100
Practice Address - Fax:270-408-6112
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100370380Medicaid
KY7100370380Medicaid