Provider Demographics
NPI:1861452401
Name:MARCY, MARY ANNE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNE
Last Name:MARCY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:ANNE
Other - Last Name:KENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:509 HWY.15 S.
Mailing Address - Street 2:FRIENDSHIP MEDICAL CLINIC
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-4502
Mailing Address - Country:US
Mailing Address - Phone:662-534-4330
Mailing Address - Fax:662-534-8665
Practice Address - Street 1:509 STATE HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-4502
Practice Address - Country:US
Practice Address - Phone:662-534-4330
Practice Address - Fax:662-534-8665
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily