Provider Demographics
NPI:1427651132
Name:MCCAY, KENNETH BRIAN (CRNP)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:BRIAN
Last Name:MCCAY
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 CENTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:AL
Mailing Address - Zip Code:35172-9477
Mailing Address - Country:US
Mailing Address - Phone:205-527-5778
Mailing Address - Fax:
Practice Address - Street 1:2040 2ND AVE E
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2818
Practice Address - Country:US
Practice Address - Phone:205-274-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-073975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily