1336287366 NPI number — BARBARA R. MACKEY

Table of content: BARBARA R. MACKEY (NPI 1336287366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336287366 NPI number — BARBARA R. MACKEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACKEY
Provider First Name:
BARBARA
Provider Middle Name:
R.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336287366
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 N GRAND AVE STE 103
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
FORT THOMAS
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41075-1765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-572-3031
Provider Business Mailing Address Fax Number:
859-344-5552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 N GRAND AVE STE 101
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FORT THOMAS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41075-1765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-344-4440
Provider Business Practice Location Address Fax Number:
859-572-3045
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  0493 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 0116 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100019920 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50000496 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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