Healthcare Provider Details

I. General information

NPI: 1548024342
Provider Name (Legal Business Name): MAKENZIE TAYLOR CAMERON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 E SEMINOLE ST
SPRINGFIELD MO
65804-2227
US

IV. Provider business mailing address

1229 E SEMINOLE ST
SPRINGFIELD MO
65804-2227
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-5150
  • Fax:
Mailing address:
  • Phone: 417-820-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2024003084
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: