Provider Demographics
NPI:1336287366
Name:MACKEY, BARBARA R
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:R
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 1:40 N GRAND AVE STE 103
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1765
Mailing Address - Country:US
Mailing Address - Phone:859-572-3031
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:40 N GRAND AVE STE 101
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1765
Practice Address - Country:US
Practice Address - Phone:859-344-4440
Practice Address - Fax:859-572-3045
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0493237700000X
KY0116231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100019920Medicaid
KY50000496Medicaid