Healthcare Provider Details

I. General information

NPI: 1083150429
Provider Name (Legal Business Name): MACKENZIE R WELDIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 6TH AVE
DES MOINES IA
50309-4109
US

IV. Provider business mailing address

317 6TH AVE
DES MOINES IA
50309-4109
US

V. Phone/Fax

Practice location:
  • Phone: 423-275-5200
  • Fax:
Mailing address:
  • Phone: 423-275-5200
  • Fax: 866-393-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-77501
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1085895
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: