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General NPI Number Information
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NPI Number | 1285229229
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Entity Type | Individual
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Provider Name | JODI MACKEY PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/02/2021
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 300 CADMAN PLZ W
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City | BROOKLYN
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State | NY
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Zip | 11201-3229
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Country | US
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Telephone | 323-205-7088
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Fax | 833-419-0181
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Provider Business Mailing Address
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Address Line | 2005 HYDE PARK BLVD
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City | NIAGARA FALLS
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State | NY
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Zip | 14305-3213
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Country | US
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Telephone | 716-478-9425
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 403371
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License Number State | NY
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