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General NPI Number Information
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NPI Number | 1205654027
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Entity Type | Individual
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Provider Name | MACKENZIE LEIGH GALE CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 1720 W GRAND ST
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City | SPRINGFIELD
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State | MO
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Zip | 65802-4802
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Country | US
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Telephone | 417-831-0150
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Fax |
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Provider Business Mailing Address
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Address Line | 2704 N 29TH ST
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City | OZARK
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State | MO
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Zip | 65721-8464
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Country | US
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Telephone | 417-350-8016
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 2001014349
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 2024040091
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License Number State | MO
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