Provider Demographics
NPI:1437232063
Name:MCELHENEY, MARY DIANE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DIANE
Last Name:MCELHENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:MCELHENEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:246 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2029
Mailing Address - Country:US
Mailing Address - Phone:859-525-7788
Mailing Address - Fax:
Practice Address - Street 1:246 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2029
Practice Address - Country:US
Practice Address - Phone:859-525-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY151492084P0800X
IN01057172A2084P0800X
OH350331592084P0800X
FLME876712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64151491Medicaid
OH0446093Medicaid
KYD32227Medicare UPIN
OH0446093Medicaid