MARY KACKLEY (NPI# 1285241554) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285241554 |
| Entity Type | Individual |
| Full Name | MARY KACKLEY |
| Practice Address |
1635 N George Mason Dr Ste 170 Arlington VA 22205-3633 |
| Mailing Address |
3040 Williams Dr Ste 100 Fairfax VA 22031-4618 |
| Practice Telephone | 7038943800 |
| Mailing Telephone | 7032805390 |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2020-09-30 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
0024180229 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | VIRGINIA BOARD OF NURSING | 0024180229 | 01 |
| Street Address |
1635 N GEORGE MASON DR STE 170 |
| City | ARLINGTON |
| State | VA |
| Zip Code | 22205-3633 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871582528 | Shawn Ellen Lipinski | Genetic Counselor, MS | 1635 N George Mason Dr Ste 170, Arlington, VA 22205-3633 | 2005-10-17 |
| 1235764135 | Sarah Dawson | Nurse Practitioner | 1635 N George Mason Dr Ste 170, Arlington, VA 22205-3633 | 2020-03-11 |
| 1235320516 | Julie Park | Nurse Practitioner | 1635 N George Mason Dr Ste 170, Arlington, VA 22205-3633 | 2007-08-05 |
| 1922063437 | Robert Joseph Christie | Specialist | 1635 N George Mason Dr Ste 170, Arlington, VA 22205-3633 | 2006-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417315722 | Ruth Jannet Figueroa Lopez | Dentist | Blvd Cucapah 19961-9, Ampliacion Loma Bonita, Tijuana, BAJA CALIFORNIA 22205 | 2016-02-01 |
| 1083004394 | Ashley Pullum | Behavioral Analyst | 874 N Nottingham St, Arlington, VA 22205 | 2015-01-26 |
| 1548601529 | Whitney C Pelton | Physical Therapist | 5910 Wilson Blvd, Sunrise Bluemont, Arlington, VA 22205 | 2013-07-08 |
| 1134490311 | Advanced Spine and Pain Pllc | Orthopaedic Surgery | 1625 N George Mason Drive Suite 345, Arlington, VA 22205 | 2012-01-20 |
| 1518269638 | Arle Zelma Samuels | Pharmacist | 5105 W1ilson Blvd, Arlington, VA 22205 | 2010-11-22 |
| 1255640686 | Geatenet G Wasia | Pharmacist | 4851 N Washington Blvd, Arlington, VA 22205 | 2010-10-04 |
| 1518272327 | Alexis S Speight | Counselor | 1725 North George Mason Dr., Arlington, VA 22205 | 2010-08-17 |
| 1821224437 | Myriam Ferzli | Obstetrics & Gynecology | 1635 N George Mason Dr Ste 190, Arlington, VA 22205 | 2009-06-09 |
| 1427232685 | United Rehab Inc. | Home Health | 1661 N. Longfellow Street, Arlington, VA 22205 | 2007-12-24 |
| 1144426404 | Teri E Minehart | Nurse Practitioner | 1701 No. George Mason Drive, Arlington, VA 22205 | 2007-06-25 |
| Find all providers in zip 22205 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053912576 | Elizabeth Ngoc Pham | Nurse Practitioner | 1502 Grey Willow Ln, Arlington, TX 76002-4631 | 2020-11-02 |
| 1609474063 | Donica West | Nurse Practitioner | 1301 E Bardin Rd Unit 181591, Arlington, TX 76096-4263 | 2020-10-16 |
| 1487268108 | Celyn Iyoke | Nurse Practitioner | 8124 Stowe Springs Ln, Arlington, TX 76002-3775 | 2020-08-31 |
| 1225641558 | Nadia Winston | Nurse Practitioner | 616 Matlock Centre Cir, Arlington, TX 76015-2536 | 2020-08-26 |
| 1205453958 | Lewis Nchoga Nyantika | Nurse Practitioner | 715 N Fielder Rd Ste C, Arlington, TX 76012-4695 | 2020-06-29 |
| 1447874102 | Friday Uhunoma Aigbedion | Nurse Practitioner | 1201 N Watson Rd Ste 268, Arlington, TX 76006-6222 | 2020-05-29 |
| 1063049625 | Mission Metroplex, Inc. | Nurse Practitioner | 212 W South St, Arlington, TX 76010-7134 | 2020-03-24 |
| 1427688381 | Rebecca Baker | Nurse Practitioner | 103 S Mesquite St Ste B, Arlington, TX 76010-1132 | 2020-01-20 |
| 1891325023 | Qutavia Shanay Winding | Nurse Practitioner | 3211 W Division St Trlr 73, Arlington, TX 76012-3478 | 2020-01-15 |
| 1730728403 | Weight Away Health and Wellness | Nurse Practitioner | 1015 Gibbins Rd Ste C, Arlington, TX 76011-5615 | 2019-12-30 |
| Find all providers in ARLINGTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.