MEDICARE: MRS. TIFFANY JACQUELINE MCKENZIE MA, LPA

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	103T00000X	Psychologist	2424	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467519082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANY JACQUELINE MCKENZIE MA, LPA

Provider Business Mailing Address
First Line	:	2013 WATERTON LN
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-9003
Country	:	US
Telephone Number	:	919-303-4941
Fax Number	:

Provider Business Practice Location Address
First Line	:	8390 SIX FORKS RD
Second Line	:	SUITE #201
City	:	RALEIGH
State	:	NC
Zip	:	27615-3060
Country	:	US
Telephone Number	:	919-782-8730
Fax Number	:	919-782-8731

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	06/03/2009

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