Healthcare Provider Details

I. General information

NPI: 1811657034
Provider Name (Legal Business Name): MACKENZI RENEE HEATON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 N MAYFAIR ST
SPOKANE WA
99208-1129
US

IV. Provider business mailing address

1306 N GREENACRES RD
SPOKANE VALLEY WA
99016-9542
US

V. Phone/Fax

Practice location:
  • Phone: 509-462-2273
  • Fax: 509-462-2275
Mailing address:
  • Phone: 509-860-1804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61265878
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60712897
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: