Provider Demographics
NPI:1497800254
Name:MCKENNEY, MARYE ANGELYN (RN, MSN, APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARYE
Middle Name:ANGELYN
Last Name:MCKENNEY
Suffix:
Gender:F
Credentials:RN, MSN, APRN
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Mailing Address - Street 1:207 DARWISH DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-3600
Mailing Address - Country:US
Mailing Address - Phone:770-957-8711
Mailing Address - Fax:
Practice Address - Street 1:3720 DAVINCI CT
Practice Address - Street 2:SUITE 400
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-7627
Practice Address - Country:US
Practice Address - Phone:770-300-3502
Practice Address - Fax:770-582-4189
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN077182 NP363LA2200X
GARN077182 NP363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology