Healthcare Provider Details

I. General information

NPI: 1598696189
Provider Name (Legal Business Name): MCKENZIE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11027 S PIKES PEAK DR STE 105
PARKER CO
80138-7361
US

IV. Provider business mailing address

3353 ZUNI ST
DENVER CO
80211-3357
US

V. Phone/Fax

Practice location:
  • Phone: 303-351-2202
  • Fax:
Mailing address:
  • Phone: 415-850-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number363LP0808X
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: