Mackenzie Gibbons, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

26479 Issued in TN

Practice address

16532 US Highway 64
Somerville, TN 38068-6185

Phone

(901) 813-8138

Fax

(901) 813-8793

NPI assigned

Sep 20, 2019

Last updated

Nov 18, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Desoto Family Medical CenterGroup PAC ID 2567470412, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baptist Home Care and Hospice North Mississippi Home health agency, Batesville, MS, CCN 257114
• Baptist Memorial Hospital Desoto Hospital, Southaven, MS, CCN 250141
• Methodist Healthcare - Olive Branch Hospital Hospital, Olive Branch, MS, CCN 250167

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Desoto Family Medical Center

  • Family Medicine Physician
  • Southaven, MS
  • NPI 1528150398

  Single Specialty

  Medicare reassignment Care Compare group NPD
• David L Seaton

  dba Seaton Family Practice

  • Family Medicine Physician
  • Somerville, TN
  • NPI 1609353192

  Single Specialty

  NPD
• Home Health Care of West Tennessee, Inc.

  dba Adoration Home Health Care West Tennessee

  • Home Health Agency
  • Cordova, TN
  • NPI 1407845944
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Baptist Memorial Hospital-Desoto, Inc,

  • General Acute Care Hospital
  • Southaven, MS
  • NPI 1194789818
  Care Compare affiliation
• LHCG Xcviii, LLC

  dba Baptist Home Care & Hospice - North Mississippi

  • Home Health Agency
  • Batesville, MS
  • NPI 1275068959
  Care Compare affiliation
• Methodist Healthcare - Olive Branch Hospital

  • General Acute Care Hospital
  • Olive Branch, MS
  • NPI 1912341439
  Care Compare affiliation

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

{
    "created_epoch": "1568937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605657600000",
    "number": "1629629761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16532 US HIGHWAY 64",
            "city": "SOMERVILLE",
            "state": "TN",
            "postal_code": "380686185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16532 US HIGHWAY 64",
            "city": "SOMERVILLE",
            "state": "TN",
            "postal_code": "380686185",
            "telephone_number": "901-813-8138",
            "fax_number": "901-813-8793"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Carson St",
            "address_purpose": "LOCATION",
            "city": "Jonesboro",
            "state": "AR",
            "postal_code": "724013104",
            "country_code": "US",
            "telephone_number": "870-932-1198",
            "fax_number": "870-910-7700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIBBONS",
        "first_name": "MACKENZIE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-20",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "26479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fayette County Schools
• Lloyann Ferrell-Bishop, APRN, FNP-BC
• Melissa Fowler, LCSW
• Garrard & Woodside LLC (Lakeview Pharmacy)
• Rolando Gentica Gersava, PT
• Elizabeth Patterson Gray, RN
• Gregory Reeves
• Charles P Haddad, OD
• Amanda H Hall, D.D.S.
• Derrick R Hamilton, MD

• Family Nurse Practitioner in Somerville, TN
• Providers in Somerville, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; 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.