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General NPI Number Information
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NPI Number | 1417549296
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Entity Type | Individual
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Provider Name | MACKENZIE JO FIELD AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 3801 N. LAMAR BLVD SUITE 300
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City | AUSTIN
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State | TX
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Zip | 78756-4080
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Country | US
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Telephone | 254-258-3440
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Fax | 512-407-1874
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Provider Business Mailing Address
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Address Line | 620 ATLANTA PARK DR
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City | GEORGETOWN
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State | TX
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Zip | 78628-7182
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Country | US
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Telephone |
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1029990
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 1029990
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1029990
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License Number State | TX
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