Healthcare Provider Details

I. General information

NPI: 1083943799
Provider Name (Legal Business Name): SANDRA CAROL MACKINEY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 N DINUBA BLVD
VISALIA CA
93291-9003
US

IV. Provider business mailing address

5957 S MOONEY BLVD
VISALIA CA
93277-9394
US

V. Phone/Fax

Practice location:
  • Phone: 559-733-6342
  • Fax:
Mailing address:
  • Phone: 559-737-4660
  • Fax: 559-737-4697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP19076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: