NPIMap

Individual provider Active NPI

Jackie A Mackey

  • Intermediate Emergency Medical Technician
  • San Fidel, NM
National Provider Identifier
1154592517
Registry record updated Mar 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intermediate Emergency Medical TechnicianTaxonomy code 146M00000X
License
03000684 Issued in NM
Practice address
Exit 102 Off I - 40 1/2 Mi South
San Fidel, NM 87049-0130
Phone
(505) 552-5385
Fax
(505) 552-5473
NPI assigned
Mar 13, 2008
Last updated
Mar 13, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intermediate Emergency Medical Technician 146M00000X 03000684 NM Primary

Addresses

Primary practice location

Exit 102 Off I - 40 1/2 Mi South
San Fidel, NM 87049-0130

Mailing address

PO Box 130
San Fidel, NM 87049-0130
Phone (505) 551-5385

Other names 1

  • Jackie A Mackey Dutton Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
03000684NMMDIntermediate Emergency Medical Technician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205366400000",
    "number": "1154592517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "SAN FIDEL",
            "state": "NM",
            "postal_code": "870490130",
            "telephone_number": "505-551-5385",
            "fax_number": "505-552-5473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "EXIT 102 OFF I - 40 1/2 MI SOUTH",
            "city": "SAN FIDEL",
            "state": "NM",
            "postal_code": "870490130",
            "telephone_number": "505-552-5385",
            "fax_number": "505-552-5473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKEY",
        "first_name": "JACKIE",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-13",
        "last_updated": "2008-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146M00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Intermediate",
            "state": "NM",
            "license": "03000684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "MACKEY DUTTON",
            "middle_name": "A",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in San Fidel, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.