Healthcare Provider Details

I. General information

NPI: 1730855735
Provider Name (Legal Business Name): MACKENZIE THOMAS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5653 FRIST BLVD STE 530
HERMITAGE TN
37076-2067
US

IV. Provider business mailing address

ONE GI CREDENTIALING DEPARTMENT PO BOX 381468
GERMANTOWN TN
38183-3945
US

V. Phone/Fax

Practice location:
  • Phone: 615-885-1110
  • Fax:
Mailing address:
  • Phone: 901-747-3630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29760
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: