Provider Demographics
NPI:1932099439
Name:BALSLEY, MACKYNSI ELAINE
Entity type:Individual
Prefix:
First Name:MACKYNSI
Middle Name:ELAINE
Last Name:BALSLEY
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 1:907 W MARTINDALE RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2929
Mailing Address - Country:US
Mailing Address - Phone:740-575-2805
Mailing Address - Fax:
Practice Address - Street 1:1618 MIDDLEFIELD CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-3175
Practice Address - Country:US
Practice Address - Phone:740-575-2805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver