Provider Demographics
NPI:1326237249
Name:MCCARTY, LAURA (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 GRINSTAFF RD
Mailing Address - Street 2:
Mailing Address - City:GAMALIEL
Mailing Address - State:KY
Mailing Address - Zip Code:42140-9323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 E 2ND ST
Practice Address - Street 2:SUITE B
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-1673
Practice Address - Country:US
Practice Address - Phone:270-487-5655
Practice Address - Fax:270-487-5948
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY27004019Medicaid