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General NPI Number Information
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NPI Number | 1003257361
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Entity Type | Individual
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Provider Name | RACHEL GREY MCKENZIE P.A.
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Gender | Female
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 104 COLLEGE DR
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City | FLAT ROCK
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State | NC
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Zip | 28731-7756
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Country | US
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Telephone | 800-226-8874
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 S OCEAN DR STE 209
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City | HOLLYWOOD
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State | FL
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Zip | 33019-2915
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Country | US
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Telephone | 800-226-8874
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-04322
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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