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General NPI Number Information
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NPI Number | 1083538714
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Entity Type | Individual
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Provider Name | MACKENZIE RENEE EHALT RBT, SRNA
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Gender | Female
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Dates
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Enumeration Date | 08/06/2026
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Last Update Date | 08/06/2026
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Provider Practice Location Address
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Address Line | 10720 PLANTSIDE DR
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City | LOUISVILLE
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State | KY
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Zip | 40299-3894
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Country | US
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Telephone | 502-260-5571
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Fax |
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Provider Business Mailing Address
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Address Line | 5205 BAYWOOD DR
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City | LOUISVILLE
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State | KY
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Zip | 40241-1314
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Country | US
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Telephone | 502-644-1198
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 4047740
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-26-518272
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License Number State | KY
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