Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Mackenzie J Weis

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1104636547

Mackenzie J Weis is a Physician Assistant in South Haven, Minnesota. Qualified in 2025, 1 year ago. Practices with Centracare Clinic, a 782-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
1
Licensed in
MN
In the registry since
2025
Specialties on file
2
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Practice location Address checks out

Student / training record This NPI belongs to someone enrolled in a health care training programme. It carries no licence and no practice of its own, so no address or phone number is published for it.

South Haven, MN

No coordinates on file. Search this address in Google Maps

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 15408 (MN)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1104636547
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJanuary 8, 2025
Last updated in NPPESJuly 2, 2025
Certification dateJuly 2, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Group practice Centracare Clinic — 782 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

Practises at

Facilities the CMS Facility Affiliation file lists for this clinician.

Colleagues at Centracare Clinic

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 782 clinicians in the practice; 12 are shown here.