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General NPI Number Information
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NPI Number | 1942017298
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Entity Type | Individual
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Provider Name | MACKENZIE KATHLEEN KELLY
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Gender | Female
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 1 CONVENTION AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4311
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Country | US
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Telephone | 215-662-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 132A VETERANS LN UNIT 117
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City | DOYLESTOWN
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State | PA
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Zip | 18901-3424
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Country | US
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Telephone | 215-806-5281
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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 | 1218151
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License Number State | PA
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