Polly Kaelin Mackey, APRN

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

3000536 Issued in KY

Practice address

4100 Taylor Blvd
Louisville, KY 40215-2342

Phone

(502) 366-4747

Fax

(502) 996-8309

NPI assigned

Feb 24, 2006

Last updated

Jun 16, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1063488690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 950244",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402950244",
            "telephone_number": "502-774-8631",
            "fax_number": "502-778-3499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 TAYLOR BLVD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402152342",
            "telephone_number": "502-366-4747",
            "fax_number": "502-996-8309"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2215 Portland Ave",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402121033",
            "country_code": "US",
            "telephone_number": "502-774-8631",
            "fax_number": "502-778-3499",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACKEY",
        "first_name": "POLLY",
        "middle_name": "KAELIN",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-24",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "KY",
            "license": "3000536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7800163300",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Mack, LPCC, NCC
• Tara Mack, PTA
• Lina Mackelaite, M.D.
• Joanna Michelle Mackens
• Dacia Wilson Mackenzie, CRNA
• William Jeffrey Mackey, RN
• Oliver James Mackie, MS
• Titerriell Macklin
• Jennifer Youngberg Mackowiak
• Taney Macleod, COTA/L

• Women's Health Nurse Practitioner in Louisville, KY
• Providers in Louisville, KY by specialty
• Women's Health Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.