Provider Demographics
NPI:1003680885
Name:MACK, NATASHA MARIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:MARIE
Last Name:MACK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:MARIE
Other - Last Name:PLANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:2911 SW WHITNEY LN
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4814
Mailing Address - Country:US
Mailing Address - Phone:785-845-9797
Mailing Address - Fax:
Practice Address - Street 1:1100 NW SOUTH OUTER RD STE 200
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3069
Practice Address - Country:US
Practice Address - Phone:888-256-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-82317-091363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily