MEDICARE: MS. MAKENZIE RECORD APRN

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
1	363LF0000X	Family Nurse Practitioner	3015603	KY

General Provider Information

NPI Number	:	1255060554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAKENZIE RECORD APRN

Provider Business Mailing Address
First Line	:	106 COMMERCIAL DR
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-1084
Country	:	US
Telephone Number	:	859-734-3482
Fax Number	:	859-734-3432

Provider Business Practice Location Address
First Line	:	106 COMMERCIAL DR
Second Line	:
City	:	HARRODSBURG
State	:	KY
Zip	:	40330-1084
Country	:	US
Telephone Number	:	859-734-3482
Fax Number	:	859-734-3432

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2022
Last Update Date	:	06/10/2022

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