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NPI Code Detail

MEDICARE: MISTY DAWN MACKINSON FNP-C

MEDICARE: MISTY DAWN MACKINSON FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse28216430AIN
2183700000XPharmacy Technician67008022AIN
3363LF0000XFamily Nurse Practitioner71012983AIN

General Provider Information

NPI Number : 1932868486
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY DAWN MACKINSON FNP-C
Provider Business Mailing Address
First Line : 2620 ELM HILL PIKE
Second Line :
City : NASHVILLE
State : TN
Zip : 37214-3108
Country : US
Telephone Number : 615-425-4200
Fax Number :
Provider Business Practice Location Address
First Line : 1330 W SOUTHPORT RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46217-5301
Country : US
Telephone Number : 317-884-4256
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2021
Last Update Date : 08/26/2022

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Directions to “ MISTY DAWN MACKINSON FNP-C” Practice Location

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