Provider Demographics
NPI:1346296241
Name:MACKEY, LINDA L (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:L
Last Name:MACKEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SOUTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503
Mailing Address - Country:US
Mailing Address - Phone:859-523-0101
Mailing Address - Fax:859-813-5251
Practice Address - Street 1:405 SOUTHLAND DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-523-0101
Practice Address - Fax:859-813-5251
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02452207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64024524Medicaid
KY64024524Medicaid
KY1712201Medicare PIN