Keith a Mackenzie DO PC

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

3225 Issued in AZ

Legal business name

KEITH A MACKENZIE DO PC

Doing business as

MacKenzie Dermatology

Practice address

3190 Clearwater Dr
Prescott, AZ 86305-7131

Phone

(928) 541-1312

Fax

(928) 541-0002

NPI assigned

Jun 9, 2009

Last updated

Oct 18, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jamie Quinn

Title

Credentialing/Billing Supervisor

Phone

(928) 541-1312

Specialties & licenses 1

Addresses

Other names 1

• MacKenzie Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Travis Lam, D.O.

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1841313020
  Medicare reassignment Care Compare group NPD
• Keith Andrew Mackenzie, D.O.

  • Procedural Dermatology Physician
  • Prescott, AZ
  • NPI 1861498297
  Medicare reassignment Care Compare group NPD
• Kimberly Carlson Stover, NP-C

  • Nurse Practitioner
  • Prescott, AZ
  • NPI 1285817122
  Medicare reassignment Care Compare group NPD
• Kaeden Litchfield

  • Family Nurse Practitioner
  • Prescott Valley, AZ
  • NPI 1437981693
  Medicare reassignment NPD

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

{
    "created_epoch": "1244505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508284800000",
    "number": "1396971958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3190 CLEARWATER DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863057131",
            "telephone_number": "928-541-1312",
            "fax_number": "928-541-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3190 CLEARWATER DR",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863057131",
            "telephone_number": "928-541-1312",
            "fax_number": "928-541-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH A MACKENZIE DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-09",
        "last_updated": "2017-10-18",
        "status": "A",
        "authorized_official_last_name": "QUINN",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "CREDENTIALING/BILLING SUPERVISOR",
        "authorized_official_telephone_number": "928-541-1312"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "AZ",
            "license": "3225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MacKenzie Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kirstin Keck, PHARMD, RPH
• Philip Earl Keen, M.D.
• Katie Elizabeth Keever, BSN, RN
• Catherine A Kefer, ANP
• Ann Kehm, P.T.
• Brenda Kellar, OT
• Greg S Keller, M.D.
• Katherine Maurine Keller, L.C.S.W.
• Melissa Marie Kelly, RN
• Kimberly Kay Kelsey, LCSW

• Procedural Dermatology Physician in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Procedural Dermatology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.