Provider Demographics
NPI:1922691583
Name:MACKEY, KAYLA (DOM, AP)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:MACKEY
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4109 BARNSLEY DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-8119
Mailing Address - Country:US
Mailing Address - Phone:321-278-3131
Mailing Address - Fax:
Practice Address - Street 1:4109 BARNSLEY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-8119
Practice Address - Country:US
Practice Address - Phone:321-278-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4223171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist