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NPI Code Detail

MEDICARE: MACKENZIE LYNN AINSWORTH FNP-C

MEDICARE:   MACKENZIE LYNN AINSWORTH  FNP-C
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
1163W00000XRegistered NurseR0118628OK
2363LF0000XFamily Nurse Practitioner118628OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770147688
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE LYNN AINSWORTH FNP-C
Provider Business Mailing Address
First Line : PO BOX 740020
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0020
Country : US
Telephone Number : 312-733-9730
Fax Number :
Provider Business Practice Location Address
First Line : 2130 SW 59TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73119-7025
Country : US
Telephone Number : 405-303-7555
Fax Number : 405-561-5615
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2019
Last Update Date : 08/16/2024

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Directions to “ MACKENZIE LYNN AINSWORTH FNP-C” Practice Location

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