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NPI Code Detail

MEDICARE: MACKENNA LEE MISUK

MEDICARE: MACKENNA LEE MISUK
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
1106S00000XBehavior TechnicianTN

General Provider Information

NPI Number : 1740143486
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENNA LEE MISUK
Provider Business Mailing Address
First Line : 1500 S DOUGLAS RD STE 230
Second Line :
City : CORAL GABLES
State : FL
Zip : 33134-4108
Country : US
Telephone Number : 844-244-1818
Fax Number :
Provider Business Practice Location Address
First Line : 6312 KINGSTON PIKE STE B
Second Line :
City : KNOXVILLE
State : TN
Zip : 37919-4958
Country : US
Telephone Number : 844-854-1116
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2025
Last Update Date : 12/09/2025

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Directions to “ MACKENNA LEE MISUK ” Practice Location

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