Provider Demographics
NPI:1669772596
Name:CARIC, MARY C (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:CARIC
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Mailing Address - Street 1:222 MEDICAL CIR
Mailing Address - Street 2:FAMILY MEDICINE
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1179
Mailing Address - Country:US
Mailing Address - Phone:606-783-6814
Mailing Address - Fax:606-783-6877
Practice Address - Street 1:316 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1550
Practice Address - Country:US
Practice Address - Phone:606-784-3771
Practice Address - Fax:606-783-6847
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3006502363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100140650Medicaid
KY7100140650Medicaid