Provider Demographics
NPI:1184801086
Name:MCELROY, KATY LEE
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:LEE
Last Name:MCELROY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GONSALVES RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2082
Mailing Address - Country:US
Mailing Address - Phone:508-957-1700
Mailing Address - Fax:508-957-1705
Practice Address - Street 1:35 GONSALVES RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2082
Practice Address - Country:US
Practice Address - Phone:508-957-1700
Practice Address - Fax:508-957-1705
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA272029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0070606093Medicare PIN