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General NPI Number Information
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NPI Number | 1114748894
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Entity Type | Individual
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Provider Name | MACKENZIE SHAE LIEDEL JONES
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Gender | Female
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 740 MIDDLE CREEK RD STE 200
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City | SEVIERVILLE
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State | TN
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Zip | 37862-5056
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Country | US
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Telephone | 865-908-9888
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Fax | 865-908-8756
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Provider Business Mailing Address
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Address Line | 740 MIDDLE CREEK RD STE 200
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City | SEVIERVILLE
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State | TN
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Zip | 37862-5056
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Country | US
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Telephone | 865-908-9888
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Fax | 865-908-8756
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 37423
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number |
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License Number State |
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