Provider Demographics
NPI:1649491432
Name:MANNING, MARY ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:MANNING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 NORTH MAYSVILLE STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MT. STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353
Mailing Address - Country:US
Mailing Address - Phone:859-404-7686
Mailing Address - Fax:859-274-0785
Practice Address - Street 1:209 NORTH MAYSVILLE STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:MT. STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353
Practice Address - Country:US
Practice Address - Phone:859-404-7686
Practice Address - Fax:859-274-0785
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004121363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
11981709OtherCAQH #
9100649OtherAETNA
KY7100045030Medicaid
000000671076OtherANTHEM BCBS
KY7100045030Medicaid
9100649OtherAETNA