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NPI Code Detail

MEDICARE: MACKINSEY DIANE JOHNSON PA-C

MEDICARE: MACKINSEY DIANE JOHNSON PA-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
1363A00000XPhysician Assistant0010-14614NC

General Provider Information

NPI Number : 1972373785
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKINSEY DIANE JOHNSON PA-C
Provider Business Mailing Address
First Line : 3207 GREGORY MANOR CT
Second Line :
City : CARY
State : NC
Zip : 27518-7152
Country : US
Telephone Number : 336-977-6537
Fax Number :
Provider Business Practice Location Address
First Line : 1301 FAYETTEVILLE ST
Second Line :
City : DURHAM
State : NC
Zip : 27707-2398
Country : US
Telephone Number : 919-956-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2024
Last Update Date : 03/05/2026

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