Mackenzie Marie Bennett, IIN

Primary specialty

Health & Wellness CoachTaxonomy code 171400000X

Practice address

4204 Georgia St
San Diego, CA 92103-2519

Phone

(206) 375-5204

NPI assigned

Jan 9, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1641686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641686400000",
    "number": "1225799562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 140427",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752140427",
            "telephone_number": "206-375-5204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4204 GEORGIA ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032519",
            "telephone_number": "206-375-5204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "MACKENZIE",
        "middle_name": "MARIE",
        "credential": "IIN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-09",
        "last_updated": "2022-01-09",
        "certification_date": "2022-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://practicebetter.io",
            "affiliation": "N",
            "endpointDescription": "private health record portal",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4204 Georgia St",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921032519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Grace Ann Bennett
• Jessica Lynn Bennett, NNP-BC
• Joshua Bennett, PA-C
• Jr Bennett, DMD
• Kevin Bennett, IMF
• Mark Bennett
• Marlena Mae Bennett, RN
• Mary Ellen Bennett, LCSW
• Melissa Province Bennett, MD
• Michael Thomas Bennett, MD

• Health & Wellness Coach in San Diego, CA
• Providers in San Diego, CA by specialty
• Health & Wellness Coach in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2022; 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.