Provider Demographics
NPI:1306394937
Name:AUSTIN, MARY K (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:K
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:MOLONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-371-1153
Mailing Address - Fax:859-647-5113
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-371-1153
Practice Address - Fax:859-647-5113
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010516363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily