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General NPI Number Information
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NPI Number | 1144947904
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Entity Type | Individual
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Provider Name | MAKENZIE ANN MCKERNAN WHNP
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Gender | Female
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 16 THIRD STREET UVMHN ALICE HYDE MEDICAL CENTER OB/GYN SUITE C
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City | MALONE
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State | NY
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Zip | 12953
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Country | US
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Telephone | 518-481-2896
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Fax | 518-481-2895
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Provider Business Mailing Address
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Address Line | 16 THIRD STREET AHMC OB/GYN & MIDWIFERY SUITE C
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City | MALONE
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State | NY
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Zip | 12953
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Country | US
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Telephone | 518-481-2896
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Fax | 518-481-2895
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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 | 421700
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 026.0142363
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License Number State | VT
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