Healthcare Provider Details

I. General information

NPI: 1861251167
Provider Name (Legal Business Name): MACKENZIE UPTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W MAIN ST
TURLOCK CA
95380-5107
US

IV. Provider business mailing address

1200 W MAIN ST
TURLOCK CA
95380-5107
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-4842
  • Fax:
Mailing address:
  • Phone: 209-722-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA64256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: