Mackenzie Rochon Clark, APNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

4852-33 Issued in WI

Practice address

5395 E Cheryl Pkwy
Fitchburg, WI 53711-5395

Phone

(608) 276-4660

NPI assigned

Jun 21, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Mackenzie Rochon Clark Former name

Medicare fee-for-service enrollment

Enrolled in WI

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Agrace Palliative Care LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Fitchburg, WI
  • NPI 1326386129
  Medicare reassignment

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

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1417396524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5395 E CHERYL PKWY",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "537115395",
            "telephone_number": "608-276-4660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5395 E CHERYL PKWY",
            "city": "FITCHBURG",
            "state": "WI",
            "postal_code": "537115395",
            "telephone_number": "608-276-4660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "MACKENZIE",
        "middle_name": "ROCHON",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-21",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "155942-30",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WI",
            "license": "4852-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MACKENZIE",
            "last_name": "CLARK",
            "middle_name": "ROCHON",
            "credential": "APNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nathaniel Ark Chin, M.D.
• Eunju Cho, NP
• Catherine Ruth Christopherson, PHARMD
• Mikayla Chryst
• Hayley Clark, LMFT
• Bintou Cole, LPN
• Alexandra M Colwell, NP
• Comfort Home Health Care
• Comfort Ride Transport LLC
• Comfort Ride Transport LLC

• Adult Health Nurse Practitioner in Fitchburg, WI
• Providers in Fitchburg, WI by specialty
• Adult Health Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; 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.