Provider Demographics
NPI:1669595369
Name:MCKAY, MICHAEL A (MSN, CRNP)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:MCKAY
Suffix:
Gender:M
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BRAMHALL STREET
Mailing Address - Street 2:MAINE MEDICAL CENTER - OUTPATIENT CLINIC
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-662-2911
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMBALL STREET- OPD CLINIC
Practice Address - Street 2:MAINE MEDICAL CENTER
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAP081897363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MER054887OtherMAINE RN LICENSE
MEAP081897OtherMAINE STATE BOARD OF NURSING
MEMM0645905OtherDEA
MEMM0645905OtherDEA
WV13381Medicare ID - Type Unspecified