Healthcare Provider Details

I. General information

NPI: 1437836863
Provider Name (Legal Business Name): MAKENZIE PAIGE BICKERS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date: 07/21/2023
Reactivation Date: 08/04/2023

III. Provider practice location address

307 N MAIN ST
WINDSOR MO
65360-1449
US

IV. Provider business mailing address

1173 SE 185
KNOB NOSTER MO
65336-2276
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax:
Mailing address:
  • Phone: 660-620-9045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-82374-012
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023048109
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2018022885
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: