Provider Demographics
NPI:1063114932
Name:MCCORMICK, CARLEY LYNN (CRNP)
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:LYNN
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 PEYTON RANDOLPH CT
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-2226
Mailing Address - Country:US
Mailing Address - Phone:717-343-2753
Mailing Address - Fax:
Practice Address - Street 1:1752 PEYTON RANDOLPH CT
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17070-2226
Practice Address - Country:US
Practice Address - Phone:717-343-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030518363LW0102X
PARN565552163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory