Healthcare Provider Details

I. General information

NPI: 1568134815
Provider Name (Legal Business Name): KYRA ELAINE MACKEY AAS, CDC 1, PSP III
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KYRA HOENACK

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N WILLOW ST
WASILLA AK
99654-7042
US

IV. Provider business mailing address

300 N WILLOW ST
WASILLA AK
99654-7042
US

V. Phone/Fax

Practice location:
  • Phone: 907-373-4357
  • Fax:
Mailing address:
  • Phone: 907-373-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number5131
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5359
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: