Provider Demographics
NPI:1205311941
Name:MCGAULEY, KEVIN MAURICE (FNP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MAURICE
Last Name:MCGAULEY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:CA
Mailing Address - Zip Code:95334-1257
Mailing Address - Country:US
Mailing Address - Phone:209-394-7913
Mailing Address - Fax:209-394-1337
Practice Address - Street 1:LIVINGSTON COMMUNITY HEALTH
Practice Address - Street 2:1140 MAIN STREET
Practice Address - City:LIVINGSTON
Practice Address - State:CA
Practice Address - Zip Code:95334
Practice Address - Country:US
Practice Address - Phone:209-394-7913
Practice Address - Fax:209-394-1337
Is Sole Proprietor?:No
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily