Provider Demographics
NPI:1659432771
Name:MCMAHEN, KAY (CNS)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:MCMAHEN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:KAY
Other - Last Name:ARDANIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNS
Mailing Address - Street 1:1522 ALBERT ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 7TH AVE
Practice Address - Street 2:ANOKA-METRO REGIONAL TREATMENT CENTER
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-4516
Practice Address - Country:US
Practice Address - Phone:651-431-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR056869-4364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR85318Medicare UPIN