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NPI Code Detail

MEDICARE: MRS. MCKENZIE HART

MEDICARE: MRS. MCKENZIE HART
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
1363A00000XPhysician AssistantPA-1637ID

General Provider Information

NPI Number : 1578059143
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MCKENZIE HART
Provider Business Mailing Address
First Line : 3200 CHANNING WAY STE A206
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83404-7586
Country : US
Telephone Number : 208-529-2230
Fax Number : 208-561-8061
Provider Business Practice Location Address
First Line : 3200 CHANNING WAY STE A206
Second Line :
City : IDAHO FALLS
State : ID
Zip : 83404-7586
Country : US
Telephone Number : 208-529-2230
Fax Number : 208-561-8061
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2018
Last Update Date : 06/09/2026

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Directions to “ MRS. MCKENZIE HART ” Practice Location

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