Provider Demographics
NPI:1376847715
Name:MCKAY, SARAH IRENE (FNP)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:IRENE
Last Name:MCKAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68498 BEEBE RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-6038
Mailing Address - Country:US
Mailing Address - Phone:269-281-7042
Mailing Address - Fax:269-235-9507
Practice Address - Street 1:3901 STONEGATE PARK STE 100
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-9136
Practice Address - Country:US
Practice Address - Phone:269-281-7042
Practice Address - Fax:269-235-9507
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704408577363L00000X
IN71003547A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704408577OtherNP LICENSE
IN201016200Medicaid
IN71003547AOtherAPN PRESCRIPTIVE AUTHORITY
INM400047445Medicare PIN
IN201016200Medicaid
IN000000710172OtherANTHEM BCBS