Provider Demographics
NPI:1467804542
Name:MACKEY, RAECHEL MARIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:RAECHEL
Middle Name:MARIE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:RAECHEL
Other - Middle Name:MARIE
Other - Last Name:LITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4101 S 4TH ST BLDG 160
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5014
Mailing Address - Country:US
Mailing Address - Phone:913-682-2000
Mailing Address - Fax:
Practice Address - Street 1:4101 S 4TH ST BLDG 160
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048
Practice Address - Country:US
Practice Address - Phone:913-683-2628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016017434363LP2300X
KS76913363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care