Mackenzee Koselke, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10005464A Issued in IN

Practice address

11783 W 1600 S
Wanatah, IN 46390-9671

Phone

(219) 307-6742

NPI assigned

Sep 16, 2026

Last updated

Sep 16, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

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": "1789516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789516800000",
    "number": "1376454215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11783 W 1600 S",
            "city": "WANATAH",
            "state": "IN",
            "postal_code": "463909671",
            "telephone_number": "219-307-6742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11783 W 1600 S",
            "city": "WANATAH",
            "state": "IN",
            "postal_code": "463909671",
            "telephone_number": "219-307-6742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSELKE",
        "first_name": "MACKENZEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-09-16",
        "last_updated": "2026-09-16",
        "certification_date": "2026-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10005464A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Wanatah, IN
• Providers in Wanatah, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2026; 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.