Healthcare Provider Details

I. General information

NPI: 1922429323
Provider Name (Legal Business Name): YYVETTE NICOLE MCKENZIE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 OLD LEONARD AVE
COLUMBUS OH
43219-2580
US

IV. Provider business mailing address

906 HIGHLAND AVE SW
WARREN OH
44485-3833
US

V. Phone/Fax

Practice location:
  • Phone: 614-815-3396
  • Fax:
Mailing address:
  • Phone: 317-771-0739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN085609-MED
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.006082
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: