Provider Demographics
NPI:1225648512
Name:CARMICHAEL, MCKENNA LAKYN
Entity Type:Individual
Prefix:
First Name:MCKENNA
Middle Name:LAKYN
Last Name:CARMICHAEL
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 1:7015 S 257TH DR
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-2364
Mailing Address - Country:US
Mailing Address - Phone:623-738-8242
Mailing Address - Fax:
Practice Address - Street 1:7015 S 257TH DR
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-2364
Practice Address - Country:US
Practice Address - Phone:623-738-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program