Individual provider Active NPI

Mary Lou McKelvey, RN

  • School Registered Nurse
  • Wayland, NY
National Provider Identifier
1104195478
Registry record updated Dec 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
School Registered NurseTaxonomy code 163WS0200X
License
223305221 Issued in NY
Practice address
2350 Route 63
Wayland, NY 14572-9509
Phone
(585) 728-2091
Fax
(585) 728-5658
NPI assigned
Dec 15, 2011
Last updated
Dec 15, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Registered Nurse 163WS0200X 223305221 NY Primary

Addresses

Primary practice location

2350 Route 63
Wayland, NY 14572-9509

Mailing address

2350 Route 63
Wayland, NY 14572-9509
Phone (585) 728-2091

Other identifiers 1

IdentifierTypeStateIssuer
166002121MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
223305221NYMDSchool Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Wayland-Cohocton Central School Past Accepting new patients
Wayland-Cohocton CSD PastSince Oct 23, 2022 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323907200000",
    "number": "1104195478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 ROUTE 63",
            "city": "WAYLAND",
            "state": "NY",
            "postal_code": "145729509",
            "telephone_number": "585-728-2091",
            "fax_number": "585-728-5658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2350 ROUTE 63",
            "city": "WAYLAND",
            "state": "NY",
            "postal_code": "145729509",
            "telephone_number": "585-728-2091",
            "fax_number": "585-728-5658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKELVEY",
        "first_name": "MARY",
        "middle_name": "LOU",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-15",
        "last_updated": "2011-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "NY",
            "license": "223305221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166002121",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayland, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.