Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mackenzie Gustafson, PMHNP

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1669101234

Mackenzie Gustafson, PMHNP is a Nurse Practitioner in Twin Falls, Idaho. Qualified in 2022, 4 years ago. Practices with St Lukes Clinic LLC, a 310-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
4
Licensed in
ID
In the registry since
2022
What do these letters mean?
PMHNP — Psychiatric-Mental Health Nurse Practitioner
A nurse practitioner specialising in mental health, able to prescribe psychiatric medication.

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Practice location Address checks out

414 Shoup Ave W Ste B
Twin Falls, ID 83301-5042
Phone: (208) 814-9100
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 59468 (ID)

Record details

NPI number1669101234
Entity typeIndividual (Type 1)
GenderFemale
Credentials PMHNP
Sole proprietorYes
NPI enumeratedJune 8, 2022
Last updated in NPPESAugust 19, 2022
Certification dateAugust 19, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice St Lukes Clinic Llc — 310 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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