Healthcare Provider Details

I. General information

NPI: 1023456878
Provider Name (Legal Business Name): MAKAYLA ANN KISER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAKAYLA ANN MULLINS DO

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BEVINS LN SUITE C
GEORGETOWN KY
40324-6120
US

IV. Provider business mailing address

4071 TATES CREEK CENTRE DR SUITE 202
LEXINGTON KY
40517-3062
US

V. Phone/Fax

Practice location:
  • Phone: 502-868-0622
  • Fax: 502-868-9097
Mailing address:
  • Phone: 502-868-0622
  • Fax: 502-868-9097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03888
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: