Provider Demographics
NPI:1154970739
Name:MCCARTY, LILY ANN
Entity type:Individual
Prefix:MRS
First Name:LILY
Middle Name:ANN
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LILY
Other - Middle Name:ANN
Other - Last Name:PROVO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434
Mailing Address - Country:US
Mailing Address - Phone:785-741-5107
Mailing Address - Fax:
Practice Address - Street 1:200 IOWA ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434
Practice Address - Country:US
Practice Address - Phone:785-741-5107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider