Healthcare Provider Details

I. General information

NPI: 1932072659
Provider Name (Legal Business Name): DAVID RAYMOND MACKEY BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 N ROXBORO ST
DURHAM NC
27704-2702
US

IV. Provider business mailing address

3109 ROWENA AVE
DURHAM NC
27703-4446
US

V. Phone/Fax

Practice location:
  • Phone: 919-470-6491
  • Fax:
Mailing address:
  • Phone: 208-840-1443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number321473
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: