KAITLYN JOLENA MCMACKIN (NPI# 1487124020) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487124020 |
| Entity Type | Individual |
| Full Name | KAITLYN JOLENA MCMACKIN |
| Credential | PA-C |
| Practice Address |
120 Fountains Blvd Ste 1000 Madison MS 39110-6343 |
| Mailing Address |
1310 N Lincoln St Apt 2a Bloomington IN 47408 |
| Practice Telephone | 7693000700 |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2020-03-23 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA00439 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363A00000X | Physician Assistant | 10002621A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
120 FOUNTAINS BLVD STE 1000 |
| City | MADISON |
| State | MS |
| Zip Code | 39110-6343 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134784689 | Therapy South - Gluckstadt LLC | Physical Therapist | 1716 Us 51, Ste N, Madison, MS 39110 | 2019-05-09 |
| 1871054098 | Summit Medical Solutions | Durable Medical Equipment & Medical Supplies | 107 Azalea Street, Madison, MS 39110 | 2019-03-29 |
| 1912488198 | Madison Medical Compounding Pharmacy | Pharmacy | 111 Fountains Blvd. Building B Ste. A, Madison, MS 39110 | 2018-08-24 |
| 1679061469 | Nuvena Vein Clinic | Anesthesiology | 120 Fountains Blvd, Madison, MS 39110 | 2018-04-26 |
| 1467960484 | Brick City Drugs, LLC | Durable Medical Equipment & Medical Supplies | 159 Fountains Blvd, Madison, MS 39110 | 2018-01-11 |
| 1093227589 | Hannah Monk Hawthorne | Counselor | 930 Ebenezer Blvd., Suite D, Madisin, MS 39110 | 2017-10-25 |
| 1548786650 | Kimberly Allen | Pharmacist | 1100 Us- 51, Madison, MS 39110 | 2017-08-21 |
| 1891218186 | Delta Elizabeth Stark | Chiropractor | 1085 Gluckstadt Rd., Bld 300 Ste E, Madison, MS 39110 | 2017-07-19 |
| 1861914848 | Laura Hartlein | Dietitian, Registered | 200 Park Circle Dr. #2, Flowood, MS 39110 | 2017-07-12 |
| 1831620608 | Ona Irby | Occupational Therapist | 105 Munich Dr, Madison, MS 39110 | 2017-03-23 |
| Find all providers in zip 39110 | ||||
| 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 |
|---|---|---|---|---|
| 1710594403 | Mary Josephine Elliott | Physician Assistant | 50 Beechwood Dr, Madison, CT 06443-1847 | 2020-09-26 |
| 1194354928 | Shqipe Ademi | Physician Assistant | 5417 Hazelcrest Dr, Madison, WI 53704-8910 | 2020-04-03 |
| 1902432685 | Therese Rowe | Physician Assistant | 1 Point Pl Ste 200, Madison, WI 53719-2836 | 2020-03-13 |
| 1437784139 | Mark Mckinney | Physician Assistant | 750 Highland Ave # Hslc1270, Madison, WI 53705-2221 | 2020-03-03 |
| 1619511706 | Nicole Frakes | Physician Assistant | 750 Highland Ave, Madison, WI 53705-2221 | 2019-10-31 |
| 1508428558 | Martha Busse | Physician Assistant | 1650 Monroe St Apt D, Madison, WI 53711-2045 | 2019-06-30 |
| 1669942249 | Patrick Soltvedt Bohn | Physician Assistant | 1034 Waban Hill, Madison, WI 53711 | 2018-11-27 |
| 1013493907 | Paulina A Hall | Physician Assistant | 700 S Park St Suite A, Madison, WI 53715-5228 | 2018-07-13 |
| 1700370020 | Mark Diaz IIi | Physician Assistant | 77 S Oakbridge Ct Apt 105, Madison, WI 53717-2030 | 2018-06-20 |
| 1881192870 | Taylor Sloan Abu-alrub | Physician Assistant | 299 Bradford Farms Dr, Madison, AL 35758-7521 | 2018-01-25 |
| Find all providers in MADISON | ||||
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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.