Provider Demographics
NPI:1841392206
Name:EGIDY, MARY LU (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LU
Last Name:EGIDY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARY LU
Other - Middle Name:
Other - Last Name:EGIDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN ARNP BC
Mailing Address - Street 1:2619 W 6TH ST. SUITE C
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:785-830-8299
Mailing Address - Fax:785-749-2581
Practice Address - Street 1:2619 W. 6TH ST. SUITE C
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049
Practice Address - Country:US
Practice Address - Phone:785-830-8299
Practice Address - Fax:785-749-2581
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-57857-101163WP0809X
KS74564363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100297790 CMedicaid
KS29894028OtherBCBS OF KC
KS160356OtherBCBS OF KS