Provider Demographics
NPI:1518499516
Name:VAN ZYL, CELYSSE MACKEY (DO)
Entity Type:Individual
Prefix:
First Name:CELYSSE
Middle Name:MACKEY
Last Name:VAN ZYL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CELYSSE
Other - Middle Name:ELIZABETH
Other - Last Name:MACKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 S LIMESTONE STE A1A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-3008
Mailing Address - Country:US
Mailing Address - Phone:859-257-3573
Mailing Address - Fax:859-323-0096
Practice Address - Street 1:310 S LIMESTONE STE A1A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-3008
Practice Address - Country:US
Practice Address - Phone:859-257-3573
Practice Address - Fax:859-323-0096
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY04689204D00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation