Healthcare Provider Details

I. General information

NPI: 1932018462
Provider Name (Legal Business Name): ANN MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 JEAN PAUL AVE
NORTH LAS VEGAS NV
89031-0642
US

IV. Provider business mailing address

1101 RED VENTURES DR
FORT MILL SC
29707-5005
US

V. Phone/Fax

Practice location:
  • Phone: 702-937-2964
  • Fax:
Mailing address:
  • Phone: 844-924-7325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: