Provider Demographics
NPI:1497592455
Name:MACKEY, SIEDA MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:SIEDA
Middle Name:MARIE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:SIEDA
Other - Middle Name:MARIE
Other - Last Name:MACKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:38058 HIGHWAY 621 STE B
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-6072
Mailing Address - Country:US
Mailing Address - Phone:225-402-2091
Mailing Address - Fax:
Practice Address - Street 1:38058 HIGHWAY 621 STE B
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-6072
Practice Address - Country:US
Practice Address - Phone:225-402-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA290500164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse