Provider Demographics
NPI:1982740536
Name:COYLE, MARY ANN (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:COYLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 FAWN RD.
Mailing Address - Street 2:
Mailing Address - City:NANCY
Mailing Address - State:KY
Mailing Address - Zip Code:42544-8676
Mailing Address - Country:US
Mailing Address - Phone:606-871-7405
Mailing Address - Fax:606-871-7405
Practice Address - Street 1:182 FAWN RD.
Practice Address - Street 2:
Practice Address - City:NANCY
Practice Address - State:KY
Practice Address - Zip Code:42544-8676
Practice Address - Country:US
Practice Address - Phone:606-871-7405
Practice Address - Fax:606-871-7405
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYDEGREE-MA-IECE174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist