McKenna Ann Mattice, MSN, FNP

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

95032116 Issued in CA

Practice address

239 Carmona
Lake Forest, CA 92630-7633

Phone

(949) 412-9274

NPI assigned

Sep 11, 2024

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science - Nursing

State licenses

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

{
    "created_epoch": "1726012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1982430393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "239 CARMONA",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926307633",
            "telephone_number": "949-412-9274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 CARMONA",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926307633",
            "telephone_number": "949-412-9274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTICE",
        "first_name": "MCKENNA",
        "middle_name": "ANN",
        "credential": "MSN, FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-11",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "95032116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.

Verify at the official NPI Registry.