Mackenzie Blackwell, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP70067727 Issued in WA

Practice address

1003 Wallace Way
Grandview, WA 98930-8805

Phone

(509) 203-1080

NPI assigned

Jun 5, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CO, WA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prosser Public Hospital District of Benton CountyGroup PAC ID 6709787872, 111 clinicians

Community Medical Group LLCGroup PAC ID 1052612785, 109 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Medical Group, LLC

  • Internal Medicine Physician
  • Grand Junction, CO
  • NPI 1043640634
  Medicare reassignment Care Compare group NPD
• Prosser Public Hospital District of Benton County

  • Critical Access Hospital
  • Prosser, WA
  • NPI 1306897681
  Medicare reassignment Care Compare group
• Community Medical Group, LLC

  • Specialist
  • Grand Junction, CO
  • NPI 1215346317
  NPD
• Community Medical Group, LLC

  • Specialist
  • Grand Junction, CO
  • NPI 1720736937
  NPD
• Community Medical Group

  • Specialist
  • Grand Junction, CO
  • NPI 1689098295
  NPD (past)
• Community Medical Group, LLC

  • Specialist
  • Grand Junction, CO
  • NPI 1538713136

  Psychiatric/Mental Health

  NPD (past)
• Community Medical Group, LLC

  • Family Medicine Physician
  • Grand Junction, CO
  • NPI 1558505503
  NPD (past)
• Community Medical Group, LLC

  • Family Medicine Physician
  • Grand Junction, CO
  • NPI 1629201637
  NPD (past)

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

{
    "created_epoch": "1717545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778544000000",
    "number": "1407697105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11590 RIDGELINE DR STE 130",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809213969",
            "telephone_number": "970-508-8101",
            "fax_number": "970-585-7849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 WALLACE WAY",
            "city": "GRANDVIEW",
            "state": "WA",
            "postal_code": "989308805",
            "telephone_number": "509-203-1080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11590 Ridgeline Dr Ste 130",
            "address_purpose": "LOCATION",
            "city": "Colorado Springs",
            "state": "CO",
            "postal_code": "809213969",
            "country_code": "US",
            "telephone_number": "970-508-8101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKWELL",
        "first_name": "MACKENZIE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-05",
        "last_updated": "2026-05-12",
        "certification_date": "2026-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP70067727",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "1665211",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CO",
            "license": "APN.1000580-NP",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Jane Beckmann, PSYD
• Aulani Miran Benitez
• Madison Marie Benjert
• Jason Val Betts, PHARMD
• Troy A Binfet, D.C.
• Guadalupe Bobadilla
• Boboth Vision Clinic Wa, PLLC
• Cole Boboth
• Everett Boboth, O.D.
• Fred C Boboth, O.D., P.S.

• Psychiatric/Mental Health Nurse Practitioner in Grandview, WA
• Providers in Grandview, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2026; 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.
• 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.