Healthcare Provider Details

I. General information

NPI: 1124844667
Provider Name (Legal Business Name): MEGAN MCKENZIE APRN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2024
Last Update Date: 11/30/2024
Certification Date: 11/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S CARSON ST
CARSON CITY NV
89701-5225
US

IV. Provider business mailing address

PO BOX 2467
GARDNERVILLE NV
89410-2467
US

V. Phone/Fax

Practice location:
  • Phone: 775-445-7330
  • Fax:
Mailing address:
  • Phone: 775-220-4735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number883177
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: