Healthcare Provider Details

I. General information

NPI: 1437793825
Provider Name (Legal Business Name): PAMELA ELAINE MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 TRUXTUN AVE
BAKERSFIELD CA
93301-3137
US

IV. Provider business mailing address

3300 TRUXTUN AVE
BAKERSFIELD CA
93301-3137
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8300
  • Fax: 661-868-8317
Mailing address:
  • Phone: 661-868-8300
  • Fax: 661-868-8317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number15001201
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: