Basic Information
Provider Information
NPI: 1003143363
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCARTY
FirstName: MARY
MiddleName: KAY
NamePrefix: MS.
NameSuffix:  
Credential: FNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 4105
Address2:  
City: PORTLAND
State: OR
PostalCode: 972084105
CountryCode: US
TelephoneNumber: 8669071068
FaxNumber: 4259179141
Practice Location
Address1: 3925 TUDOR CENTRE DR
Address2: #100
City: ANCHORAGE
State: AK
PostalCode: 995085931
CountryCode: US
TelephoneNumber: 9075618301
FaxNumber: 9075618170
Other Information
ProviderEnumerationDate: 11/06/2009
LastUpdateDate: 02/16/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X1109AKY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

ID Information
IDTypeStateIssuerDescription
102229405AK MEDICAID


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