Active NPI
Michelle C McCreary, MD
- Pediatrics Physician
- Jacksonville, FL
National Provider Identifier
1114365764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- ME 126764
- Practice address
- 2121 Park St
Jacksonville, FL 32204-3811 - Phone
- (904) 387-6200
- Fax
- (904) 387-0261
- NPI assigned
- Jun 5, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | ME 126764 | FL | Primary |
Addresses
Primary practice location
2121 Park St
Jacksonville, FL 32204-3811
Mailing address
2121 Park St
Jacksonville, FL 32204-3811
Phone (904) 387-6200
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME 126764 | FL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467676800000",
"number": "1114365764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2121 PARK ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322043811",
"telephone_number": "904-387-6200",
"fax_number": "904-387-0261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 PARK ST",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322043811",
"telephone_number": "904-387-6200",
"fax_number": "904-387-0261"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCREARY",
"first_name": "MICHELLE",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-05",
"last_updated": "2016-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "ME 126764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.