Active NPI
Mackenzie Nicole Pemberton, EMT, CPSS
- Peer Specialist
- Flint, MI
National Provider Identifier
1679380596
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 1063 Professional Dr Ste D4
Flint, MI 48532-3636 - Phone
- (810) 496-4937
- NPI assigned
- Dec 13, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | MI | Primary |
Addresses
Primary practice location
1063 Professional Dr Ste D4
Flint, MI 48532-3636
Mailing address
1063 Professional Dr Ste D4
Flint, MI 48532-3636
Phone (810) 496-4937
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
- Emergency Medical Technician
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1734048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734048000000",
"number": "1679380596",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1063 PROFESSIONAL DR STE D4",
"city": "FLINT",
"state": "MI",
"postal_code": "485323636",
"telephone_number": "810-496-4937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1063 PROFESSIONAL DR STE D4",
"city": "FLINT",
"state": "MI",
"postal_code": "485323636",
"telephone_number": "810-496-4937"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEMBERTON",
"first_name": "MACKENZIE",
"middle_name": "NICOLE",
"name_prefix": "Miss",
"credential": "EMT, CPSS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-12-13",
"last_updated": "2024-12-13",
"certification_date": "2024-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "MI",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flint, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.