Provider Demographics
NPI: | 1780031997 |
---|---|
Name: | MACKEY, LINDA (ND, FNP-BC, PMHNP) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | LINDA |
Middle Name: | |
Last Name: | MACKEY |
Suffix: | |
Gender: | F |
Credentials: | ND, FNP-BC, PMHNP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1385 N SALIDA DEL SOL |
Mailing Address - Street 2: | |
Mailing Address - City: | CHANDLER |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85224-8524 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 951-236-1150 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7575 E EARLL DR |
Practice Address - Street 2: | |
Practice Address - City: | SCOTTSDALE |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85251-6915 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-448-7500 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2016-05-17 |
Last Update Date: | 2019-11-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 09-1125 | 175F00000X |
AZ | AP8791 | 364SF0001X, 363LP0808X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |
No | 175F00000X | Other Service Providers | Naturopath | |
No | 364SF0001X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health |