Provider Demographics
NPI:1003110131
Name:MACKEY, BARBARA CHARLENE (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:CHARLENE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 S ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:TEWKBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-3221
Mailing Address - Country:US
Mailing Address - Phone:603-438-0866
Mailing Address - Fax:
Practice Address - Street 1:1261 FURNACE BROOK PKWY
Practice Address - Street 2:SUITE 31
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4721
Practice Address - Country:US
Practice Address - Phone:617-479-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164567363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health