Provider Demographics
NPI:1184774960
Name:MCBRAYER, MICHELLE A (ARNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:MCBRAYER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 NEWTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1217
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:859-254-2743
Practice Address - Street 1:26 N HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2024
Practice Address - Country:US
Practice Address - Phone:859-253-1686
Practice Address - Fax:859-254-2743
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1033796363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY0331822Medicare ID - Type UnspecifiedMEDICARE
KY30615058Medicaid
KY0331614Medicare ID - Type UnspecifiedMEDICARE
KY3316Medicare ID - Type UnspecifiedMEDICARE
KYP05240Medicare UPIN
KY0332012Medicare ID - Type UnspecifiedMEDICARE