Provider Demographics
NPI:1528805165
Name:MALICIA-MACKAY, KERRY-ANN
Entity type:Individual
Prefix:
First Name:KERRY-ANN
Middle Name:
Last Name:MALICIA-MACKAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 GRINNELL ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-6215
Mailing Address - Country:US
Mailing Address - Phone:508-287-9914
Mailing Address - Fax:
Practice Address - Street 1:34 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02744-2610
Practice Address - Country:US
Practice Address - Phone:508-999-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN63586164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse