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NPI Code Detail

MEDICARE: MACKENZIE BLACKWELL PMHNP-BC

MEDICARE: MACKENZIE BLACKWELL PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPN.1000580-NPCO
2163W00000XRegistered Nurse1665211CO

General Provider Information

NPI Number : 1407697105
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE BLACKWELL PMHNP-BC
Provider Business Mailing Address
First Line : 603 28 1/4 RD
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81506-6019
Country : US
Telephone Number : 970-263-2600
Fax Number :
Provider Business Practice Location Address
First Line : 603 28 1/4 RD
Second Line :
City : GRAND JUNCTION
State : CO
Zip : 81506-6019
Country : US
Telephone Number : 970-263-2600
Fax Number : 970-263-2692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2024
Last Update Date : 01/27/2026

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Directions to “ MACKENZIE BLACKWELL PMHNP-BC” Practice Location

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