KATHLEEN ANN MACK (NPI# 1326211624) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326211624 |
| Entity Type | Individual |
| Full Name | KATHLEEN ANN MACK |
| Credential | ARNP |
| Practice Address |
612 Country Clb Tooele UT 84074-9604 |
| Practice Telephone | 5097315662 |
| Mailing Telephone | 5097315662 |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2013-08-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
RN00106768 | WA | Nursing Service Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
AP30008033 | WA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881073518 | Kathleen Mack | Behavioral Analyst | 3655 Childress Ave, Saint Louis, MO 63109-1309 | 2015-05-27 |
| 1982679403 | Kathleen A. Mack | Psychologist | 8 Triangle Park Dr, Suite 804, Cincinnati, OH 45246-3404 | 2006-02-19 |
| 1417306879 | Kathleen Mack | Peer Specialist | 412 E North St, Suite A, Waukesha, WI 53188-3720 | 2016-06-07 |
| 1932352002 | Kathleen Theresa Mack | Nurse Practitioner | 1560 Garrett Rd, Upper Darby, PA 19082-4516 | 2008-11-02 |
| Street Address |
612 COUNTRY CLB |
| City | TOOELE |
| State | UT |
| Zip Code | 84074-9604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689233397 | Leah Elizabeth Harper I | Behavior Technician | 39 Millpond Stansbury Park, Tooele, UT 84074 | 2019-06-07 |
| 1245710789 | Tanna Marie Shelley | Community Health Worker | 27 So Main St, Tooele, UT 84074 | 2018-08-15 |
| 1528548062 | Barbara T Cederlof | Community Health Worker | 27 South Main St., Tooele, UT 84074 | 2018-08-15 |
| 1235615600 | Ashley Christine Wilson | Case Manager/Care Coordinator | 27 South Main, Tooele, UT 84074 | 2018-07-18 |
| 1174016976 | Makenzie Green | Case Manager/Care Coordinator | 27 S Main, Tooele, UT 84074 | 2018-06-07 |
| 1386151835 | Monica Lee | Physical Therapist | 6727 Ut-36 #300, Stansbury Park, UT 84074 | 2018-01-05 |
| 1871976183 | Pagnani Physical Therapy | Physical Therapist | 6727 North State Hwy 36, Suite 300, Stansbury Park, UT 84074 | 2015-07-06 |
| 1407248222 | Pebble Creek Counseling Center | Counselor | 494 E 2400 N Ste B, Tooele, UT 84074 | 2015-03-03 |
| 1528496221 | Emily Carlson | Case Manager/Care Coordinator | 220 North Millpond Rd, Suite 100, Stansbury Park, UT 84074 | 2013-10-16 |
| 1710327218 | Angela Michelle Demoss | Nurse Practitioner | 682 Country Club, Stansbury Park, UT 84074 | 2013-06-28 |
| Find all providers in zip 84074 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295955821 | Frances Margaret Matuszewski | Nurse Practitioner | 85 W Vine St, Tooele, UT 84074-2034 | 2007-04-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114536737 | Bradley Martin | Nurse Practitioner | 31 M St Apt 110, Salt Lake City, UT 84103-3846 | 2020-07-29 |
| 1710595178 | Shannon Lee Zaryoun | Nurse Practitioner | 7970 S Grand Vista Way, Cottonwood Heights, UT 84121-5683 | 2020-07-21 |
| 1023640851 | Senior Nurse Practitioner Consultants | Nurse Practitioner | 5802 S 900 E # 3, Murray, UT 84121-1644 | 2020-02-10 |
| 1245877448 | Carla Lucile Applegate-anderson | Nurse Practitioner | 2666 South 2000 East, Suite 101, Salt Lake City, UT 84109 | 2019-12-06 |
| 1124676044 | Marie R. Hurst | Nurse Practitioner | 5974 Fashion Point Dr Ste 140, South Ogden, UT 84403-4838 | 2019-09-04 |
| 1437706058 | Austin Sumner Heaps | Nurse Practitioner | 1044 N 600 E, Morgan, UT 84050-9269 | 2019-08-19 |
| 1821565839 | Clint Lee Martineau | Nurse Practitioner | 230 N 1680 E # 1, Saint George, UT 84790-2579 | 2018-10-28 |
| 1356827505 | Ashley Smith | Nurse Practitioner | 515 N 600 E, Hyrum, UT 84319-1133 | 2018-07-11 |
| 1588176606 | Bradley Keep | Nurse Practitioner | 4610 W 9980 N, Cedar Hills, UT 84062-8728 | 2017-10-30 |
| 1023548070 | Sarah Leggett | Nurse Practitioner | 9235 S Redwood Rd Ste A, West Jordan, UT 84088-5811 | 2017-06-13 |
| 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.