Healthcare Provider Details

I. General information

NPI: 1912586314
Provider Name (Legal Business Name): MACKENZIE HUMPHREY PREWITT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 990
DANVILLE KY
40423-0990
US

IV. Provider business mailing address

800 ROSE ST STE MN275
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-239-2222
  • Fax:
Mailing address:
  • Phone: 859-323-6162
  • Fax: 859-257-8934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number62198
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: