Provider Demographics
NPI:1447763032
Name:MCVAY, CHARISSA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:CHARISSA
Middle Name:MARIE
Last Name:MCVAY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14210 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-8399
Mailing Address - Country:US
Mailing Address - Phone:903-244-8672
Mailing Address - Fax:
Practice Address - Street 1:3915 W 8TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-2028
Practice Address - Country:US
Practice Address - Phone:501-280-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005335363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty