MACKENZIE JACQUELYN BLUST (NPI# 1346707841) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346707841 |
| Entity Type | Individual |
| Full Name | MACKENZIE JACQUELYN BLUST |
| Credential | PA-C |
| Practice Address |
304 Detroit St La Porte IN 46350-2497 |
| Practice Telephone | 2193253770 |
| Practice Fax Number | 2193258181 |
| Mailing Telephone | 2193253770 |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2020-09-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 10002814A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 5601008969 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2222 W Buell Rd, Oakland, MI 483632104 | 2489789775 |
| Street Address |
304 DETROIT ST |
| City | LA PORTE |
| State | IN |
| Zip Code | 46350-2497 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730189820 | Neil William Wangstrom | Otolaryngology | 304 Detroit St, La Porte, IN 46350-2497 | 2005-07-29 |
| 1972776292 | Jessica L Nichols | Audiologist | 304 Detroit St, La Porte, IN 46350-2497 | 2008-04-08 |
| 1750456356 | Jerry A Montgomery | Social Worker | 304 Detroit St, Suite A, La Porte, IN 46350-2473 | 2006-11-21 |
| 1043307978 | Neil Wangstrom Md PC | Audiologist | 304 Detroit St, La Porte, IN 46350-2473 | 2006-10-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871139246 | Carolyn Ann Perra | Pharmacist | 55 Pine Lake S.c., Laporte, IN 46350 | 2019-11-20 |
| 1306496492 | Trinity Healthcare Inc. | Occupational Therapist | 2002 Andrew Avenue, Laporte, IN 46350 | 2019-09-19 |
| 1184136665 | Diane Margaret Rich | Physical Therapist | 1643 S Willow Bend Dr, La Porte, IN 46350 | 2017-10-24 |
| 1114460102 | Judith Marie Fitzhugh | Dietitian, Registered | 1775 S. Basswood Trail, Laporte, IN 46350 | 2016-11-23 |
| 1568916971 | Total Renal Care, Inc. | Clinic/Center | 1406 E Lincolnway, Ste A, La Porte, IN 46350 | 2016-08-15 |
| 1083079008 | Irene Torres | Nurse Practitioner | 1407 Lincolnway, La Porte, IN 46350 | 2015-12-17 |
| 1124422910 | Becky Alwood-wallace | Occupational Therapist | 1203 Washington Street, Iu Health La Porte Hospital Wellness & Rehabilitation, La Porte, IN 46350 | 2014-10-22 |
| 1881001527 | Johnson Memorial Hospital | Skilled Nursing Facility | 3530 Monroe Street, La Porte, IN 46350 | 2014-07-15 |
| 1306268941 | Tiffany Anne Satterfield | Physical Therapy Assistant | 194 S 400 E, Laporte, IN 46350 | 2014-01-16 |
| 1801122239 | Mary Barbara Backer | Internal Medicine | 301 Willow Bend Dr, La Porte, IN 46350 | 2009-10-20 |
| Find all providers in zip 46350 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881040004 | Ashley Michelle Gilbert | Physician Assistant | 11006 Spencer Hwy, La Porte, TX 77571-4416 | 2016-05-06 |
| 1295108942 | Dustin T Simcoe | Physician Assistant | 401 Newporte Blvd, La Porte, IN 46350-4099 | 2015-11-03 |
| 1144691478 | North Indiana Emergency Physicians, LLP | Physician Assistant | 1007 Lincolnway, La Porte, IN 46350-3201 | 2015-10-13 |
| 1659660439 | Megan Whitney Johnson | Physician Assistant | 11006 Spencer Hwy, La Porte, TX 77571 | 2011-04-01 |
| 1275558942 | Maple City Emergency Physicians, LLP | Physician Assistant | 1007 Lincolnway, La Porte, IN 46350-3201 | 2006-07-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275133894 | Kaylin Michelle Lapel | Physician Assistant | 1540 Orchard Park Dr N, Carmel, IN 46280-1513 | 2020-11-01 |
| 1639779739 | Brock Sokolowski | Physician Assistant | 4581 Nikki Dr Apt D, Indianapolis, IN 46237-1703 | 2020-10-28 |
| 1699373357 | Dillon Etter | Physician Assistant | 2848 N Delaware St, Indianapolis, IN 46205-4118 | 2020-10-15 |
| 1417555996 | Kathleen Wiles | Physician Assistant | 3805 Pine Creek Cir, New Albany, IN 47150-2057 | 2020-10-15 |
| 1962017210 | Taylor Lee Bowen | Physician Assistant | 2760 Woodwind Way, Indianapolis, IN 46268-4233 | 2020-09-14 |
| 1275148421 | James Cameron Fields | Physician Assistant | 532 Bridgestone Dr, Mooresville, IN 46158-7304 | 2020-09-14 |
| 1912512476 | William Terrell Parmenter | Physician Assistant | 2230 English Ave, Indianapolis, IN 46201-4017 | 2020-09-11 |
| 1457966376 | Angela Shearon | Physician Assistant | 4325 N College Ave, Indianapolis, IN 46205-1931 | 2020-09-09 |
| 1831702570 | Nathan Dean Hailey | Physician Assistant | 1115 Ronald Reagan Pkwy Ste 247, Avon, IN 46123-6911 | 2020-08-24 |
| 1104438944 | Erin R Griffin | Physician Assistant | 5621 Woodshire Dr Apt 5, Fort Wayne, IN 46835-2959 | 2020-08-22 |
| Find all providers with the same taxonomy | ||||
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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.