Provider Demographics
NPI:1730964057
Name:MACKLEY, KAITLYN JOY (CD(DONA))
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:JOY
Last Name:MACKLEY
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 FEREBEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-1717
Mailing Address - Country:US
Mailing Address - Phone:757-715-3554
Mailing Address - Fax:
Practice Address - Street 1:1123 FEREBEE AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-1717
Practice Address - Country:US
Practice Address - Phone:757-715-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula