Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 3000536 | KY |
NPI | 1063488690 |
---|---|
Provider Name | Ms. Polly Kaelin Mackey |
First Address | Louisville, KY 40295-0244 |
Second Address | Louisville, KY 40215-2342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7800163300 | (05) | KY |