Basic Information
| Provider Information | |||||||||
| NPI: | 1043986532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IVY | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | MCKAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3901A SPICEWOOD SPRINGS RD STE 201 | ||||||||
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| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787598728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7372266700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 4TH ST | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713018421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7372266700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2021 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 221578 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.