JOHN D MACKENNEY PA NPI 1841472479

NPI Information

  • NPI: 1841472479
  • Provider Name: JOHN D MACKENNEY PA
  • Classification: Podiatrist - 213ES0103X
  • Specialization: Foot & Ankle Surgery
  • Entity Type: Organization
  • Doing Business As: SPACE COAST FOOT & ANKLE CENTER
  • Address: 6550 N WICKHAM RD STE 4
    MELBOURNE, FL
    ZIP 32940
  • Phone: (321) 259-4268

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NPI Details

JOHN D MACKENNEY PA is a foot and ankle surgery podiatrist in Melbourne, FL. JOHN D MACKENNEY PA NPI is 1841472479. The provider is registered as an organization entity type.
The provider Is Doing Business As Space Coast Foot & Ankle Center.

The provider's business location address is:

6550 N WICKHAM RD STE 4
MELBOURNE, FL
ZIP 32940-038
Phone: (321) 259-4268

The provider's authorized official is John David Mackenney .
The authorized official title is OWNER PHYSICIANPhysician and has the following contact phone number (321) 259-4268.

The enumeration date for this NPI number is 12/5/2007 and was last updated on 8/9/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332B00000XDurable Medical Equipment & Medical SuppliesNo
2213ES0103XPodiatristFoot & Ankle SurgeryPO3043FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
15013550001MEDICARE NSCFLORIDA
2U96263MEDICARE UPINFLORIDA
3340376900MEDICAIDFLORIDA
465811ZMEDICARE PINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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