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General NPI Number Information
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NPI Number | 1609629559
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Entity Type | Individual
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Provider Name | MACKENZIE GIFFORD
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Gender | Female
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 1729 KINNEYS LN STE 102
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City | PORTSMOUTH
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State | OH
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Zip | 45662-3166
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Country | US
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Telephone | 740-351-0980
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Fax |
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Provider Business Mailing Address
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Address Line | 74 SHAWNEE LN
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City | LUCASVILLE
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State | OH
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Zip | 45648-8526
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Country | US
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Telephone | 740-352-9205
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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