Individual provider Active NPI

Kimberly Davis Mackenzie, FNP

  • Nurse Practitioner
  • Dallas, TX
National Provider Identifier
1801356902
Registry record updated Feb 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AP140748 Issued in TX
Practice address
5939 Harry Hines Boulevard 7TH Floor Suite 700
Dallas, TX 75390-8987
Phone
(214) 645-1919
NPI assigned
Mar 23, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP140748 TX
Nurse Practitioner 363L00000X AP140748 TX Primary

Addresses

Primary practice location

5939 Harry Hines Boulevard 7TH Floor Suite 700
Dallas, TX 75390-8987

Mailing address

PO Box 845347
Dallas, TX 75284-7208
Phone (617) 633-5555

Other practice location 1

4944 Preston Rd Ste 100A
Frisco, TX 75034-8987
Phone (469) 304-3443

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210218001589 TX Practitioner - Nurse Practitioner 2062827330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
University of Texas Southwestern Medical Center at DallasGroup PAC ID 0648188250, 3,156 clinicians

Practice addresses (Care Compare)

5939 Harry Hines Blvd
Dallas, TX 75235-6246
Phone (214) 645-0624

Hospital & facility affiliations

  • Ut of Texas Southwestern University Hospital - William P. Clements Jr. Hospital, Dallas, TX, CCN 450044

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP140748TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Jan 19, 2021 Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Jan 19, 2021 Accepting new patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients

Locations

5939 Harry Hines Blvd
Dallas, TX 75235
Phone (214) 645-1919

2201 Inwood Rd
Dallas, TX 75235
Phone (214) 645-2563

5939 Harry Hines Blvd
Ste 700
Dallas, TX 75235
Phone (214) 645-1919

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

3621 22nd St
Ste 400
Lubbock, TX 79410
Phone (806) 791-8484

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1553299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612742400000",
    "number": "1801356902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 845347",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752847208",
            "telephone_number": "617-633-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5939 HARRY HINES BOULEVARD 7TH FLOOR SUITE 700",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753908987",
            "telephone_number": "214-645-1919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4944 Preston Rd Ste 100A",
            "address_purpose": "LOCATION",
            "city": "Frisco",
            "state": "TX",
            "postal_code": "750348987",
            "country_code": "US",
            "telephone_number": "469-304-3443",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACKENZIE",
        "first_name": "KIMBERLY",
        "middle_name": "DAVIS",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-23",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP140748",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP140748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.