Basic Information
| Provider Information | |||||||||
| NPI: | 1336287366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACKEY | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | R. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 N GRAND AVE STE 103 | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | FORT THOMAS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410751765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595723031 | ||||||||
| FaxNumber: | 8593445552 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 N GRAND AVE STE 101 | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | FORT THOMAS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410751765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593444440 | ||||||||
| FaxNumber: | 8595723045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 0493 | KY | N | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist | 231H00000X | 0116 | KY | Y | Speech, Language and Hearing Service Providers | Audiologist |
ID Information
| ID | Type | State | Issuer | Description | 7100019920 | 05 | KY | MEDICAID | 50000496 | 05 | KY | MEDICAID |