Provider Demographics
NPI:1144719493
Name:MCCARTY, JEFFREY D (RN)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
Last Name:MCCARTY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 PAIUTE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4114
Mailing Address - Country:US
Mailing Address - Phone:502-762-5949
Mailing Address - Fax:
Practice Address - Street 1:4835 POPLAR LEVEL RD STE 110
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-2906
Practice Address - Country:US
Practice Address - Phone:855-591-0092
Practice Address - Fax:502-631-9660
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1125995163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management