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General NPI Number Information
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NPI Number | 1760965370
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Entity Type | Individual
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Provider Name | KRISTIN MCKENZIE PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/10/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 1400 SE GOLDTREE DR STE 102-104
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-7582
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Country | US
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Telephone | 772-335-8446
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Fax |
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Provider Business Mailing Address
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Address Line | 2461 SW MAPLEWOOD DR
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City | PALM CITY
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State | FL
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Zip | 34990-2734
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Country | US
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Telephone | 772-233-3135
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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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