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General NPI Number Information
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NPI Number | 1730865320
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Entity Type | Individual
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Provider Name | MCKENZIE KORI JEFFERSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 461 WESTERN BLVD STE 122
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City | JACKSONVILLE
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State | NC
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Zip | 28546-7637
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Country | US
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Telephone | 910-333-0283
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Fax | 910-333-0513
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Provider Business Mailing Address
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Address Line | 105 WATERS LNDG
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City | STAFFORD
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State | VA
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Zip | 22554-7833
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Country | US
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Telephone | 706-892-9740
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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 | 5021906
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License Number State | NC
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