Individual provider Active NPI

Courtney Ann Mackinnon, WHNP-BC

  • Women's Health Nurse Practitioner
  • Show Low, AZ
National Provider Identifier
1861023921
Registry record updated Aug 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
237275 Issued in AZ
Practice address
4951 S White Mountain Rd BLDG a
Show Low, AZ 85901-7827
Phone
(928) 537-6700
Fax
(928) 532-2198
NPI assigned
Jan 28, 2020
Last updated
Aug 6, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 237275 AZ Primary

Addresses

Primary practice location

4951 S White Mountain Rd BLDG a
Show Low, AZ 85901-7827

Mailing address

4951 S White Mountain Rd BLDG a
Show Low, AZ 85901-7827
Phone (928) 537-6700

Other practice location 1

5300 S Sutter Dr Ste 11
Show Low, AZ 85901-8055
Phone (928) 537-9844

Other identifiers 1

IdentifierTypeStateIssuer
002629MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20200309001384 AZ Practitioner - Nurse Practitioner 4789012667 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Cincinnati College of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4951 S White Mountain Rd
BLDG a
Show Low, AZ 85901-7801
Phone (928) 537-6700

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
237275AZMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Healthcare Medical Associates Nurse Practitioner Current Accepting new patients
Summit Healthcare Association Nurse Practitioner Current Accepting new patients
Summit Healthcare Medical Associates CurrentSince Oct 1, 2023 Accepting new patients
Summit Healthcare Medical Associates CurrentSince Oct 1, 2023 Accepting new patients
Summit Healthcare Association Past Accepting new patients

Locations

1401 W Florida St
Holbrook, AZ 86025
Phone (928) 251-0386

5171 S Cub Lake Rd
Ste B210
Show Low, AZ 85901
Phone (928) 532-8386

2200 E Show Low Lake Rd
Show Low, AZ 85901
Phone (928) 537-4375

4951 S White Mountain Rd
Show Low, AZ 85901
Phone (928) 532-5848

4951 S White Mountain Rd
Bldg A
Show Low, AZ 85901
Phone (928) 537-6700

Interoperability endpoints

  • Direct secure messaging: courtneymackinnon@shrmcshma.allscriptsdirect.net

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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": "1580169600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785974400000",
    "number": "1861023921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4951 S WHITE MOUNTAIN RD BLDG A",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859017827",
            "telephone_number": "928-537-6700",
            "fax_number": "928-532-2198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4951 S WHITE MOUNTAIN RD BLDG A",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859017827",
            "telephone_number": "928-537-6700",
            "fax_number": "928-532-2198"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5300 S Sutter Dr Ste 11",
            "address_purpose": "LOCATION",
            "city": "Show Low",
            "state": "AZ",
            "postal_code": "859018055",
            "country_code": "US",
            "telephone_number": "928-537-9844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACKINNON",
        "first_name": "COURTNEY",
        "middle_name": "ANN",
        "credential": "WHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-01-28",
        "last_updated": "2026-08-06",
        "certification_date": "2026-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "AZ",
            "license": "237275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002629",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Show Low, AZ

Sources for this page

Verify at the official NPI Registry.