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General NPI Number Information
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NPI Number | 1699597674
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Entity Type | Individual
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Provider Name | MCKENZIE OLIVIA COMPTON
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Gender | Female
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 126 W CLINTON ST
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City | GRAY
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State | GA
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Zip | 31032-5322
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Country | US
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Telephone | 478-221-3075
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Fax |
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Provider Business Mailing Address
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Address Line | 427 OLIVER GREENE RD
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City | GRAY
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State | GA
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Zip | 31032-5509
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Country | US
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Telephone | 478-960-3599
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN295358
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License Number State | GA
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