Provider Demographics
NPI:1497649917
Name:CORRIVEAU, MAKENSEE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MAKENSEE
Middle Name:
Last Name:CORRIVEAU
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3453 ALDERSHOT DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-4201
Mailing Address - Country:US
Mailing Address - Phone:859-333-3925
Mailing Address - Fax:
Practice Address - Street 1:68 E ELKINS ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-2311
Practice Address - Country:US
Practice Address - Phone:859-404-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4041607363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health