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NPI Code Detail

MEDICARE: MACKENZIE BUSHERY

MEDICARE: MACKENZIE BUSHERY
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
1163W00000XRegistered Nurse1061535TX

General Provider Information

NPI Number : 1407789662
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE BUSHERY
Provider Business Mailing Address
First Line : 1816 CARDINAL WAY
Second Line :
City : NORTHLAKE
State : TX
Zip : 76226-2623
Country : US
Telephone Number : 715-304-7460
Fax Number :
Provider Business Practice Location Address
First Line : 3500 GASTON AVE
Second Line :
City : DALLAS
State : TX
Zip : 75246-2017
Country : US
Telephone Number : 214-820-0111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2026
Last Update Date : 06/06/2026

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Directions to “ MACKENZIE BUSHERY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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