Healthcare Provider Details

I. General information

NPI: 1265351324
Provider Name (Legal Business Name): MECHELL MARIE MCKENZIE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 E FLAMINGO RD STE H
LAS VEGAS NV
89121-5208
US

IV. Provider business mailing address

2950 E FLAMINGO RD STE H
LAS VEGAS NV
89121-5208
US

V. Phone/Fax

Practice location:
  • Phone: 725-251-3854
  • Fax: 725-780-1114
Mailing address:
  • Phone: 725-251-3854
  • Fax: 725-780-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number704399
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number899666
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: