Individual provider Active NPI

David Phillip Mackey Jr., FNP-BC

  • Family Nurse Practitioner
  • Tupelo, MS
National Provider Identifier
1609131358
Registry record updated Apr 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R857999 Issued in MS
Practice address
845 S Madison St
Tupelo, MS 38801-4905
Phone
(662) 377-5930
Fax
(662) 377-5085
NPI assigned
Jul 9, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Registered Nurse 163WH0200X R857999 MS
Family Nurse Practitioner 363LF0000X R857999 MS Primary

Addresses

Primary practice location

845 S Madison St
Tupelo, MS 38801-4905

Mailing address

5482 Highway 15 N
Ecru, MS 38841-8471
Phone (662) 488-8799

Other identifiers 1

IdentifierTypeStateIssuer
03824819MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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

Enrollment IDStateProvider typePAC IDDetails
I20130125000405 MS Practitioner - Nurse Practitioner 4385898436 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midnight-Medical, Inc.Group PAC ID 9436284239, 2 clinicians

Practice addresses (Care Compare)

848 S Madison St
Tupelo, MS 38801-4905
Phone (662) 844-4177

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midnight-Medical, Inc. Family CurrentSince Jun 14, 2018 Accepting new patients

Locations

848 S Madison St
Tupelo, MS 38801
Phone (662) 844-4177

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.

NPI Registry JSON

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

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585699200000",
    "number": "1609131358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5482 HIGHWAY 15 N",
            "city": "ECRU",
            "state": "MS",
            "postal_code": "388418471",
            "telephone_number": "662-488-8799",
            "fax_number": "662-488-8729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 S MADISON ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014905",
            "telephone_number": "662-377-5930",
            "fax_number": "662-377-5085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACKEY",
        "first_name": "DAVID",
        "middle_name": "PHILLIP",
        "name_suffix": "Jr.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-09",
        "last_updated": "2020-04-01",
        "certification_date": "2020-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "MS",
            "license": "R857999",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R857999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03824819",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

Verify at the official NPI Registry.