Provider Demographics
NPI:1962856286
Name:MCVAY, KIMLYN (RN)
Entity Type:Individual
Prefix:
First Name:KIMLYN
Middle Name:
Last Name:MCVAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S SAINT ANDREWS ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3684
Mailing Address - Country:US
Mailing Address - Phone:334-793-1177
Mailing Address - Fax:
Practice Address - Street 1:950 S SAINT ANDREWS ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3684
Practice Address - Country:US
Practice Address - Phone:334-793-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-131586163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-131586OtherALABAMA BOARD OF NURSING
FL9416827OtherFLORIDA DEPARTMENT OF HEALTH