Provider Demographics
NPI:1740579754
Name:MACKEY, KIRSTEN K (DO)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:K
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 1:10368 DONNER PASS RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0427
Mailing Address - Country:US
Mailing Address - Phone:530-213-0709
Mailing Address - Fax:
Practice Address - Street 1:10368 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0427
Practice Address - Country:US
Practice Address - Phone:530-213-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT102858207Q00000X
NVDO1884207Q00000X
CA20A13533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine