Provider Demographics
NPI:1285893552
Name:MACKEY, CAROLE LEE (APN)
Entity type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:LEE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ARCADIA CIR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-3102
Mailing Address - Country:US
Mailing Address - Phone:501-847-6468
Mailing Address - Fax:
Practice Address - Street 1:3600 CANTRELL RD
Practice Address - Street 2:STE 205 SLOT 512-33
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-1893
Practice Address - Country:US
Practice Address - Phone:501-526-8027
Practice Address - Fax:501-526-8014
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01903ANP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics