MEDICARE: MCKENZIE BROADWAY FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4051627	KY

General Provider Information

NPI Number	:	1093673238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZIE BROADWAY FNP-BC

Provider Business Mailing Address
First Line	:	120 RIDGEWOOD RD
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-5254
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 RIDGEWOOD RD
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-5254
Country	:	US
Telephone Number	:	615-585-9098
Fax Number	:	615-585-9098

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	03/02/2026

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Directions to “ MCKENZIE BROADWAY FNP-BC” Practice Location

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