Provider Demographics
NPI:1285198572
Name:HOLM-MOFFITT, MACKENZIE MARGARET (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:MARGARET
Last Name:HOLM-MOFFITT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MACKENZIE
Other - Middle Name:MARGARET
Other - Last Name:HOLM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 S SYCAMORE AVE APT 111
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-4498
Mailing Address - Country:US
Mailing Address - Phone:605-370-1145
Mailing Address - Fax:
Practice Address - Street 1:6215 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8596
Practice Address - Country:US
Practice Address - Phone:605-322-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant