Provider Demographics
NPI:1518582550
Name:CONROY, MARYKATE (NP)
Entity type:Individual
Prefix:
First Name:MARYKATE
Middle Name:
Last Name:CONROY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 E HARRISBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-9004
Mailing Address - Country:US
Mailing Address - Phone:484-818-0052
Mailing Address - Fax:
Practice Address - Street 1:1808 COLONIAL VILLAGE LN STE 103
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6709
Practice Address - Country:US
Practice Address - Phone:484-818-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN627315163W00000X
PASP024376363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
RN627315OtherRN LICENSE
PASP024376OtherNURSE PRACTITIONER LICENSE