Healthcare Provider Details

I. General information

NPI: 1629492277
Provider Name (Legal Business Name): MACKENZIE CLOTWORTHY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27800 NORTHWEST FWY
CYPRESS TX
77433-5302
US

IV. Provider business mailing address

6431 FANNIN ST STE MSB3.244
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 137-704-4000
  • Fax: 713-704-5269
Mailing address:
  • Phone: 713-704-4000
  • Fax: 713-604-5269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP127107
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP127107
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: