Provider Demographics
NPI:1013321835
Name:MACKEY, JENNIFER K (CNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:MACKEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:POLOMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6770 MAYFIELD RD # 421
Mailing Address - Street 2:HC40
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2299
Mailing Address - Country:US
Mailing Address - Phone:440-312-7689
Mailing Address - Fax:440-449-7715
Practice Address - Street 1:6770 MAYFIELD RD # 421
Practice Address - Street 2:HC40
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2299
Practice Address - Country:US
Practice Address - Phone:440-312-7689
Practice Address - Fax:440-449-7715
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 16057-NP363LA2200X
OHRN 332567363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health