Mary Cordellia Dwyer, APRN- BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

3012846 Issued in KY

Practice address

228 Hopkinsville St
Greenville, KY 42345-1214

Phone

(270) 377-3077

Fax

(270) 377-3002

NPI assigned

Nov 1, 2018

Last updated

Feb 11, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Health Centers of Western Kentucky, Inc.Group PAC ID 5193769370, 23 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Community Health Centers of Western Kentucky, Inc.

  • Federally Qualified Health Center (FQHC)
  • Greenville, KY
  • NPI 1306848650
  Medicare reassignment Care Compare group NPD
• Community Health Centers of Western Kentucky Inc

  • Obstetrics & Gynecology Physician
  • Greenville, KY
  • NPI 1376088930

  Psychiatric/Mental Health

  NPD
• Community Health Centers of Western Kentucky, Inc.

  • Federally Qualified Health Center (FQHC)
  • Greenville, KY
  • NPI 1164275491
  NPD

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

{
    "created_epoch": "1541030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1255808747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 HOPKINSVILLE ST",
            "city": "GREENVILLE",
            "state": "KY",
            "postal_code": "423451124",
            "telephone_number": "270-338-5777",
            "fax_number": "270-338-5765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 HOPKINSVILLE ST",
            "city": "GREENVILLE",
            "state": "KY",
            "postal_code": "423451214",
            "telephone_number": "270-377-3077",
            "fax_number": "270-377-3002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DWYER",
        "first_name": "MARY",
        "middle_name": "CORDELLIA",
        "name_prefix": "Ms.",
        "credential": "APRN- BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-01",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "3012846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diversicare of Greenville, LLC (Diversicare of Greenville)
• Allison Ducoff
• Lisa Kaa Dukes, MSN,ARNP
• Melissa Dukes
• Donna Marillyn Dunlap, PTA
• William Bryan Eades, DMD
• Eagle Acquisition II, LLC (Concordia Nursing and Rehabilitation - Maple)
• Alicia Evans, MFT
• Family Practice of Greenville PSC (Marshall E Prunty MD)
• Angela Fitzhugh

• Psychiatric/Mental Health Nurse Practitioner in Greenville, KY
• Providers in Greenville, KY by specialty
• Psychiatric/Mental Health Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.