Provider Demographics
NPI:1831668110
Name:MCCOOL, MARTHA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:MCCOOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 MADISON AVE
Mailing Address - Street 2:PMB #87
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:646-979-8031
Mailing Address - Fax:
Practice Address - Street 1:2578 BROADWAY # 607
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5642
Practice Address - Country:US
Practice Address - Phone:646-979-8031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61445607363LP0808X
MDAC004144363LP0808X
TNAPN0000024885363LP0808X
NY405009363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AC004144OtherMD BOARD OF NURSING, CRNP-PMH
TNAPN0000024885OtherAPRN LICENSE
NY405009OtherNY BOARD OF NURSING, NURSE PRACTITIONER IN PSYCHIATRY
WAAP61445607OtherWA BOARD OF NURSING, ADVANCED REGISTERED NURSE PRACTITIONER LICENSE