Healthcare Provider Details

I. General information

NPI: 1972321156
Provider Name (Legal Business Name): DARBY MACKENSTADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

10401 W THUNDERBIRD BLVD
SUN CITY AZ
85351-3004
US

V. Phone/Fax

Practice location:
  • Phone: 615-327-4751
  • Fax:
Mailing address:
  • Phone: 623-977-7211
  • Fax: 419-242-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberNA
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: