Mackenzie C Moe, APRN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

12267 Issued in MN

Practice address

7525 Mitchell Rd Ste 100
Eden Prairie, MN 55344-1900

Phone

(612) 915-0049

NPI assigned

Nov 5, 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

Enrolled in MN

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, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Innovations IncGroup PAC ID 6204178528, 96 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lifestancehealth.mackenziemoe@149810.advancedmd-direct.com

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.

• Family Innovations, Inc.

  • Counseling Psychologist
  • Anoka, MN
  • NPI 1992862783

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• West Central Counseling LLC

  • Mental Health Counselor
  • Alexandria, MN
  • NPI 1649846650
  NPD (past)

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

{
    "created_epoch": "1730764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752019200000",
    "number": "1992528376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N SCOTTSDALE RD STE 2500",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517630",
            "telephone_number": "612-915-0049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7525 MITCHELL RD STE 100",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553441900",
            "telephone_number": "612-915-0049"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 E Main St",
            "address_purpose": "LOCATION",
            "city": "Mankato",
            "state": "MN",
            "postal_code": "560013501",
            "country_code": "US",
            "telephone_number": "952-520-2315",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOE",
        "first_name": "MACKENZIE",
        "middle_name": "C",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-05",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "12267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Said A Moalimyusuf
• Zuhayb Moallim
• Katherine Manning Moberg
• Mobile PT MN, LLC
• Mobilerehabmn
• Steven Moe, DC
• Deirdre Michelle Moes, OTR
• Ahmed Hussein Mohamed
• Filsan Mohamed
• Ilyas Kasim Mohamed

• Psychiatric/Mental Health Nurse Practitioner in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Psychiatric/Mental Health Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2025; 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.