Provider Demographics
NPI:1104161116
Name:MCGINNIS, MARCIA ELISE (APRN)
Entity type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:ELISE
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 S. FIFTH STREET
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3066
Mailing Address - Country:US
Mailing Address - Phone:574-546-1900
Mailing Address - Fax:574-546-1999
Practice Address - Street 1:5905 GRANDEL BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3099
Practice Address - Country:US
Practice Address - Phone:502-489-7351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-02
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007793363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily