Provider Demographics
NPI:1073283982
Name:DOUGLAS, MACAYLA
Entity Type:Individual
Prefix:
First Name:MACAYLA
Middle Name:
Last Name:DOUGLAS
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 1:505 HECKS PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-8423
Mailing Address - Country:US
Mailing Address - Phone:606-462-1327
Mailing Address - Fax:
Practice Address - Street 1:505 HECKS PLAZA DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-8423
Practice Address - Country:US
Practice Address - Phone:606-462-1327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator