Active NPI
McKenna Nelson
- Physician Assistant
- Tuba City, AZ
National Provider Identifier
1508672205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 11412
- Practice address
- PO Box 600
Tuba City, AZ 86045-0600 - Phone
- (928) 856-4314
- NPI assigned
- Dec 6, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | 11412 | AZ | Primary |
Addresses
Primary practice location
PO Box 600
Tuba City, AZ 86045-0600
Mailing address
9550 Stardust TRL
Flagstaff, AZ 86004-1136
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
PO Box
Suite 600
Tuba City, AZ 86045
PO Box
Suite 600
Tuba City, AZ 86045-0600
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11412 | AZ | MD | Physician Assistant |
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Tuba City, AZ
- NPI 1548294424
TX
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Tuba City, AZ
- NPI 1548294424
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1733443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774224000000",
"number": "1508672205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9550 STARDUST TRL",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860041136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "PO BOX 600",
"city": "TUBA CITY",
"state": "AZ",
"postal_code": "860450600",
"telephone_number": "928-856-4314"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "MCKENNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-12-06",
"last_updated": "2026-03-23",
"certification_date": "2026-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "11412",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tuba City, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.