Healthcare Provider Details

I. General information

NPI: 1407558406
Provider Name (Legal Business Name): MCKENZIE XIANG DENTON OSTRANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 09/11/2025
Certification Date: 07/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

428 WESTPORT WAY
FLOWOOD MS
39232-7544
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-1000
  • Fax:
Mailing address:
  • Phone: 662-610-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT-4955
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: