Healthcare Provider Details

I. General information

NPI: 1578417382
Provider Name (Legal Business Name): MRS. FINISH MODELL MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 13TH AVE
PHENIX CITY AL
36867-5618
US

IV. Provider business mailing address

1214 13TH AVE
PHENIX CITY AL
36867-5618
US

V. Phone/Fax

Practice location:
  • Phone: 706-332-0210
  • Fax: 706-332-0210
Mailing address:
  • Phone: 706-332-0210
  • Fax: 706-332-0210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: