Provider Demographics
NPI:1801511738
Name:MIDKIFF, SKY COREY-BLAKE
Entity type:Individual
Prefix:
First Name:SKY
Middle Name:COREY-BLAKE
Last Name:MIDKIFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:COREY
Other - Middle Name:BLAKE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1351 NEWTOWN PIKE BLDG 1
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-1277
Mailing Address - Country:US
Mailing Address - Phone:859-253-1686
Mailing Address - Fax:
Practice Address - Street 1:1060 GLENSBORO RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-9033
Practice Address - Country:US
Practice Address - Phone:502-839-7203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor