Active NPI
Jennifer E Mackenzie, MS, ATC, NREMT-B
- Athletic Trainer
- Des Moines, WA
National Provider Identifier
1548785637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- A160647869
- Practice address
- 22450 19TH Ave S
Des Moines, WA 98198-7623 - Phone
- (206) 631-7019
- NPI assigned
- Aug 9, 2017
- Last updated
- Aug 9, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | A160647869 | WA | Primary |
Addresses
Primary practice location
22450 19TH Ave S
Des Moines, WA 98198-7623
Mailing address
9220 NE Bluefin CT
Bainbridge Island, WA 98110-4603
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A160647869 | WA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502236800000",
"number": "1548785637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9220 NE BLUEFIN CT",
"city": "BAINBRIDGE ISLAND",
"state": "WA",
"postal_code": "981104603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22450 19TH AVE S",
"city": "DES MOINES",
"state": "WA",
"postal_code": "981987623",
"telephone_number": "206-631-7019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACKENZIE",
"first_name": "JENNIFER",
"middle_name": "E",
"credential": "MS, ATC, NREMT-B",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-08-09",
"last_updated": "2017-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WA",
"license": "A160647869",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Des Moines, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.