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General NPI Number Information
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NPI Number | 1861023921
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Entity Type | Individual
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Provider Name | COURTNEY ANN MACKINNON WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 11/16/2023
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Provider Practice Location Address
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Address Line | 4951 S WHITE MOUNTAIN RD BLDG A
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City | SHOW LOW
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State | AZ
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Zip | 85901-7827
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Country | US
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Telephone | 928-537-6700
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Fax | 928-537-4439
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Provider Business Mailing Address
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Address Line | 1190 E PINE OAKS DR
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City | SHOW LOW
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State | AZ
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Zip | 85901-7356
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Country | US
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Telephone | 928-242-4347
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 237275
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License Number State | AZ
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