Provider Demographics
NPI:1477838910
Name:MCCARTY, KENDALL MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:MARIE
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 DICKERSON PIKE STE 370
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2535
Mailing Address - Country:US
Mailing Address - Phone:615-769-2799
Mailing Address - Fax:
Practice Address - Street 1:3443 DICKERSON PIKE STE 370
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2535
Practice Address - Country:US
Practice Address - Phone:615-769-2799
Practice Address - Fax:615-769-2789
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2384363A00000X
SC1729363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1289PAMedicaid
SCAA79797951Medicare PIN