Provider Demographics
NPI:1023456878
Name:KISER, MAKAYLA ANN (DO)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:ANN
Last Name:KISER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MAKAYLA
Other - Middle Name:ANN
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4071 TATES CREEK CENTRE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3062
Mailing Address - Country:US
Mailing Address - Phone:502-868-0622
Mailing Address - Fax:502-868-9097
Practice Address - Street 1:210 BEVINS LN
Practice Address - Street 2:SUITE C
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-6120
Practice Address - Country:US
Practice Address - Phone:502-868-0622
Practice Address - Fax:502-868-9097
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine