Provider Demographics
NPI:1144481854
Name:MACKEY, CAROLYN JOYCE
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JOYCE
Last Name:MACKEY
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 1:411 E INDIAN SCHOOL RD APT 1063
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1872
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 E INDIAN SCHOOL RD
Practice Address - Street 2:1063
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1844
Practice Address - Country:US
Practice Address - Phone:210-542-3092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203957164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse