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

Claim this listing Report a problem Suggest an edit

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 number	1104636547
Entity type	Individual (Type 1)
Gender	Female
Sole proprietor	Yes
NPI enumerated	January 8, 2025
Last updated in NPPES	July 2, 2025
Certification date	July 2, 2025

Medicare enrollment

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

Medicare specialty	PHYSICIAN ASSISTANT
Medical school	OTHER
Graduated	2025 (1 years in practice)
Group practice	Centracare Clinic — 782 clinicians
Accepts Medicare assignment	Yes — accepts the Medicare-approved amount
Practice locations	6 on file with Medicare