Provider Demographics
NPI:1962992685
Name:MACKEY, CHARLENE ESSIE (RRT)
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:ESSIE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:MRS
Other - First Name:CHARLENE
Other - Middle Name:ESSIE
Other - Last Name:MACKEY-SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RRT
Mailing Address - Street 1:4004 S BAMBOO DR
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5823
Mailing Address - Country:US
Mailing Address - Phone:504-914-2500
Mailing Address - Fax:504-309-5786
Practice Address - Street 1:5620 READ BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3106
Practice Address - Country:US
Practice Address - Phone:504-592-6851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRCP02001401227900000X
LA000598227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered