Healthcare Provider Details

I. General information

NPI: 1639024219
Provider Name (Legal Business Name): MACKENZIE ASENATH WHITE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date: 03/07/2026
Reactivation Date: 05/04/2026

III. Provider practice location address

5103 BELLA VISTA DR
LONGMONT CO
80503-4123
US

IV. Provider business mailing address

5103 BELLA VISTA DRIVE
LONGMONT CO
80503-4123
US

V. Phone/Fax

Practice location:
  • Phone: 720-899-8838
  • Fax:
Mailing address:
  • Phone: 720-899-8838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025099398
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: