Provider Demographics
NPI:1427017763
Name:MACKEY, DUSTI L (CRNA)
Entity type:Individual
Prefix:
First Name:DUSTI
Middle Name:L
Last Name:MACKEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DUSTI
Other - Middle Name:
Other - Last Name:SLAUGHTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5327 N CENTRAL EXPY
Mailing Address - Street 2:STE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5327 N CENTRAL EXPY
Practice Address - Street 2:#200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3361
Practice Address - Country:US
Practice Address - Phone:214-520-8235
Practice Address - Fax:214-520-8236
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR64009367500000X
TX131106367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162552001Medicaid
AR5Y879OtherBCBS
AR5Y879Medicare PIN