Provider Demographics
NPI:1649622622
Name:MCKAY, CHONTAY L (FNP-C)
Entity type:Individual
Prefix:MS
First Name:CHONTAY
Middle Name:L
Last Name:MCKAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 TIMBERWOOD TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-7511
Mailing Address - Country:US
Mailing Address - Phone:314-313-2804
Mailing Address - Fax:
Practice Address - Street 1:601 JAMES R THOMPSON BLVD
Practice Address - Street 2:BUILDING D, SUITE 2015
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-1129
Practice Address - Country:US
Practice Address - Phone:618-482-6959
Practice Address - Fax:618-482-8311
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014333363LF0000X
MO2015043224363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGMedicaid