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NPI Code Detail

MEDICARE: MS. KRISTINE M. MACKEY PNP

MEDICARE: MS. KRISTINE M. MACKEY PNP
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
1363LP0200XPediatric Nurse Practitioner254712CA

General Provider Information

NPI Number : 1831233584
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRISTINE M. MACKEY PNP
Provider Business Mailing Address
First Line : 2650 S BRISTOL ST
Second Line : STE. 101
City : SANTA ANA
State : CA
Zip : 92704-5751
Country : US
Telephone Number : 714-754-1444
Fax Number : 714-754-7009
Provider Business Practice Location Address
First Line : 2650 S BRISTOL ST
Second Line : STE. 101
City : SANTA ANA
State : CA
Zip : 92704-5751
Country : US
Telephone Number : 714-754-1444
Fax Number : 714-754-7009
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2007
Last Update Date : 01/11/2012

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