Healthcare Provider Details

I. General information

NPI: 1366643975
Provider Name (Legal Business Name): KATHRYN JOYCE MCKENZIE N.D., L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 N CENTRAL EXPY SUITE 190
DALLAS TX
75231-8600
US

IV. Provider business mailing address

10300 N CENTRAL EXPY SUITE 190
DALLAS TX
75231-8600
US

V. Phone/Fax

Practice location:
  • Phone: 469-500-9828
  • Fax:
Mailing address:
  • Phone: 469-500-9828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC-10077
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND129
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01364
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: