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NPI Code Detail

MEDICARE: MRS. MAKENZIE WHITLEY DNP, FNP-C

MEDICARE: MRS. MAKENZIE WHITLEY DNP, FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner5024066NC
2363L00000XNurse Practitioner5024066NC

General Provider Information

NPI Number : 1164378782
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MAKENZIE WHITLEY DNP, FNP-C
Provider Business Mailing Address
First Line : 11386 CAMP CHARLES RD
Second Line :
City : BAILEY
State : NC
Zip : 27807-8866
Country : US
Telephone Number : 252-299-3070
Fax Number :
Provider Business Practice Location Address
First Line : 620 DR CALVIN JONES HWY STE 208
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-3108
Country : US
Telephone Number : 984-204-8801
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2026
Last Update Date : 03/18/2026

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