Healthcare Provider Details

I. General information

NPI: 1932099439
Provider Name (Legal Business Name): MACKYNSI ELAINE BALSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 MIDDLEFIELD CT
DAYTON OH
45414-3175
US

IV. Provider business mailing address

907 W MARTINDALE RD
ENGLEWOOD OH
45322-2929
US

V. Phone/Fax

Practice location:
  • Phone: 740-575-2805
  • Fax:
Mailing address:
  • Phone: 740-575-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: