Provider Demographics
NPI:1912715590
Name:MACKEY, JESSICA REANN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:REANN
Last Name:MACKEY
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 1:12324 S 33RD ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1614
Mailing Address - Country:US
Mailing Address - Phone:402-332-9050
Mailing Address - Fax:
Practice Address - Street 1:12324 S 33RD ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1614
Practice Address - Country:US
Practice Address - Phone:402-332-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services