Mackenzie Kaelyn Poole, MD, MBA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2024020290 Issued in MO

Practice address

621 S New Ballas Rd Ste 3019B
Saint Louis, MO 63141-8267

Phone

(314) 509-5305

Fax

(314) 251-4454

NPI assigned

Apr 8, 2024

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

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine

State licenses

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

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1366295842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 3019B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418267",
            "telephone_number": "314-509-5305",
            "fax_number": "314-251-4454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 S NEW BALLAS RD STE 3019B",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418267",
            "telephone_number": "314-509-5305",
            "fax_number": "314-251-4454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POOLE",
        "first_name": "MACKENZIE",
        "middle_name": "KAELYN",
        "credential": "MD, MBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-08",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MO",
            "license": "2024020290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Rekay Pool, CRNA
• Renee Lyn Pool, RN
• Chantell L Poole
• Joyce L Poole, LCSW
• Kate Poole, OT
• Mark Ellsworth Poole
• Jordan Poore, MOT, OTR/L
• Morgan Rebecca Poore, OD
• Nongnooch Poowanawittayakom, MD
• Abbi Lyn Pope ( Piper)

• Dermatology Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Dermatology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.