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General NPI Number Information
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NPI Number | 1912681123
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Entity Type | Individual
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Provider Name | LESLI JOHNELL MCKENZIE APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/09/2023
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 3201 S AUSTIN AVE STE 255
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City | GEORGETOWN
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State | TX
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Zip | 78626-7644
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Country | US
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Telephone | 512-501-4287
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Fax | 512-651-8444
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Provider Business Mailing Address
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Address Line | 3201 S AUSTIN AVE STE 255
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City | GEORGETOWN
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State | TX
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Zip | 78626-7644
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Country | US
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Telephone | 512-501-4287
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Fax | 512-651-8444
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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 | 1124908
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1124908
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License Number State | TX
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