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

Stacey Mackay

Individual provider Family Medicine Physician · NPI 1760469175

Stacey Mackay is a Family Practice in St Louis Park, Minnesota. Graduated from University of Virginia School of Medicine in 1992, 34 years ago. Practices with Park Nicollet Clinic, a 1,773-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
34
Trained at
University of Virginia School of Medicine
Licensed in
MN
In the registry since
2005
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Practice location Address checks out

3850 Park Nicollet Blvd Park Nicollet Clinic - Slp
St Louis Park, MN 55416
Phone: (952) 993-3025
Fax: (952) 993-1937
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2220 Riverside Ave, Minneapolis, MN 55454-1321 — (612) 371-1600

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 41342 (MN)

Record details

NPI number1760469175
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedDecember 28, 2005
Last updated in NPPESAugust 14, 2018

Medicare enrollment

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

Medicare specialtyFAMILY PRACTICE
Medical schoolUNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE
Graduated 1992 (34 years in practice)
Group practice Park Nicollet Clinic — 1773 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

Other providers in St Louis Park