Provider Demographics
NPI:1932180718
Name:MCKAY, BERNICE GAYLE (APRN)
Entity type:Individual
Prefix:
First Name:BERNICE
Middle Name:GAYLE
Last Name:MCKAY
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 1:184 LIBERTY ST
Mailing Address - Street 2:YALE PSYCHIATRIC INSTITUTE
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1625
Mailing Address - Country:US
Mailing Address - Phone:203-688-9920
Mailing Address - Fax:203-737-2221
Practice Address - Street 1:184 LIBERTY ST
Practice Address - Street 2:YALE PSYCHIATRIC INSTITUTE
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1625
Practice Address - Country:US
Practice Address - Phone:203-688-9920
Practice Address - Fax:203-737-2221
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000215364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004204442Medicaid
CTS79316Medicare UPIN
CT004204442Medicaid