Individual
MISTY DAWN MACKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1330 W SOUTHPORT RD, INDIANAPOLIS, IN 46217-5301
(317) 884-4256
Mailing address
2620 ELM HILL PIKE, NASHVILLE, TN 37214-3108
(615) 425-4200
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28216430A
IN
183700000X
Pharmacy Technician
67008022A
IN
363LF0000X
Family Nurse Practitioner
Primary
71012983A
IN
Other
Enumeration date
12/13/2021
Last updated
08/26/2022
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