Provider Demographics
NPI:1891222105
Name:NOVOTNY, KACY (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KACY
Middle Name:
Last Name:NOVOTNY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04758-3403
Mailing Address - Country:US
Mailing Address - Phone:207-429-8333
Mailing Address - Fax:207-425-7875
Practice Address - Street 1:106 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:ME
Practice Address - Zip Code:04758-3403
Practice Address - Country:US
Practice Address - Phone:207-429-8333
Practice Address - Fax:207-425-7875
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ279247Medicaid