MEDICARE: KATHY MCKENZIE

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	164W00000X	Licensed Practical Nurse	322353	NY

General Provider Information

NPI Number	:	1629500855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY MCKENZIE

Provider Business Mailing Address
First Line	:	3078 AVENUE W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5508
Country	:	US
Telephone Number	:	646-431-3457
Fax Number	:

Provider Business Practice Location Address
First Line	:	3078 AVENUE W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5508
Country	:	US
Telephone Number	:	646-431-3457
Fax Number	:

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

Provider Enumeration Date	:	03/28/2017
Last Update Date	:	03/28/2017

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