Provider Demographics
NPI:1053718593
Name:MACKEY, ISAIAH WILLIAM
Entity type:Individual
Prefix:MR
First Name:ISAIAH
Middle Name:WILLIAM
Last Name:MACKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 LOSEE RD
Mailing Address - Street 2:APT 1068
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-2479
Mailing Address - Country:US
Mailing Address - Phone:315-440-2427
Mailing Address - Fax:
Practice Address - Street 1:5005 LOSEE RD
Practice Address - Street 2:APT 1068
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-2479
Practice Address - Country:US
Practice Address - Phone:315-440-2427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator