Provider Demographics
NPI:1194860015
Name:MCCAA, AIMEE LYNN (APRN)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:LYNN
Last Name:MCCAA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:131 STONECREST RD STE 100
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8163
Practice Address - Country:US
Practice Address - Phone:502-633-7093
Practice Address - Fax:502-633-7094
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002599363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00887134OtherRAILROAD MEDICARE
KY3002599OtherKY APRN LICENSE
KY1056804OtherRN
KY3002599OtherKY APRN LICENSE