Healthcare Provider Details

I. General information

NPI: 1275492266
Provider Name (Legal Business Name): JESSE MCKENZIE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 S RIGGSVILLE DR
MOUNTAIN VIEW AR
72560-6167
US

IV. Provider business mailing address

326 S RIGGSVILLE DR
MOUNTAIN VIEW AR
72560-6167
US

V. Phone/Fax

Practice location:
  • Phone: 601-517-6552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number218146
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: