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General NPI Number Information
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NPI Number | 1629598651
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Entity Type | Individual
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Provider Name | MCKENZIE CHERIE FREDERICK APRN
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Gender | Female
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 701 ANTLER DR STE 209
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City | CASPER
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State | WY
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Zip | 82601-1749
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Country | US
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Telephone | 307-209-9636
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Fax | 307-459-6805
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Provider Business Mailing Address
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Address Line | 701 ANTLER DR STE 209
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City | CASPER
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State | WY
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Zip | 82601-1749
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Country | US
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Telephone | 307-209-9636
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Fax | 307-459-6805
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 54604
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License Number State | WY
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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 | 38068
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License Number State | WY
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