Active NPI
Mary McKillop
- Specialist
- Ravena, NY
National Provider Identifier
1891243218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 304575
- Practice address
- 14379 RT 9W
Circle of Friends
Ravena, NY 12143-3103 - Phone
- (518) 756-3124
- Fax
- (518) 756-9476
- NPI assigned
- Sep 14, 2016
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 304575 | NY | Primary |
Addresses
Primary practice location
14379 RT 9W
Circle of Friends
Ravena, NY 12143-3103
Mailing address
14379 RT 9W
Circle of Friends
Ravena, NY 12143-3103
Phone (518) 756-3124
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 304575 | NY | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1473811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473811200000",
"number": "1891243218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14379 RT 9W",
"address_2": "CIRCLE OF FRIENDS",
"city": "RAVENA",
"state": "NY",
"postal_code": "121433103",
"telephone_number": "518-756-3124",
"fax_number": "518-756-9476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14379 RT 9W",
"address_2": "CIRCLE OF FRIENDS",
"city": "RAVENA",
"state": "NY",
"postal_code": "121433103",
"telephone_number": "518-756-3124",
"fax_number": "518-756-9476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCKILLOP",
"first_name": "MARY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-14",
"last_updated": "2016-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": "304575",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ravena, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.