Healthcare Provider Details

I. General information

NPI: 1558953059
Provider Name (Legal Business Name): MACKENZIE LYNN CARLSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 05/01/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 15TH ST N
HUMBOLDT IA
50548-1008
US

IV. Provider business mailing address

2410 220TH ST
HUMBOLDT IA
50548-8802
US

V. Phone/Fax

Practice location:
  • Phone: 515-332-4200
  • Fax:
Mailing address:
  • Phone: 712-358-0816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA162658
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2020169468
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: