Provider Demographics
NPI:1104430297
Name:MCQUEARY, MACI (APRN)
Entity type:Individual
Prefix:
First Name:MACI
Middle Name:
Last Name:MCQUEARY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MACI
Other - Middle Name:LAKIN
Other - Last Name:CHRISTIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2503 LONE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-8213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 HOTCHKISS ST
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-1340
Practice Address - Country:US
Practice Address - Phone:270-465-0191
Practice Address - Fax:270-465-0463
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily