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General NPI Number Information
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NPI Number | 1982333704
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Entity Type | Individual
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Provider Name | MACKENZIE CARROLL DO
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Gender | Female
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Dates
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Enumeration Date | 06/07/2022
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 1530 US HIGHWAY 25 E
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City | MIDDLESBORO
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State | KY
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Zip | 40965-1861
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Country | US
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Telephone | 606-654-9450
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Fax | 606-302-4240
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Provider Business Mailing Address
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Address Line | PO BOX 40
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City | WHITESBURG
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State | KY
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Zip | 41858-0040
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Country | US
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Telephone | 606-633-4823
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 06091
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License Number State | KY
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