Healthcare Provider Details

I. General information

NPI: 1972440105
Provider Name (Legal Business Name): HUGH URIE MACKENZIE IV FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 US HIGHWAY 61
CRYSTAL CTY MO
63028-4100
US

IV. Provider business mailing address

4322 LOCKEPORT LNDG
HILLSBORO MO
63050-3629
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-1111
  • Fax:
Mailing address:
  • Phone: 636-208-7212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026028092
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: