MEDICARE: MACKENZIE RAYE OWENS CLARK WHNP

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	163W00000X	Registered Nurse	253743	TN
2	363LW0102X	Women's Health Nurse Practitioner	32574	TN

General Provider Information

NPI Number	:	1710602636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE RAYE OWENS CLARK WHNP

Provider Business Mailing Address
First Line	:	1101 WILSON BLVD FL 6
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-2281
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1928 ALCOA HWY
Second Line	:	MEDICAL BUILDING B, SUITE 300
City	:	KNOXVILLE
State	:	TN
Zip	:	37920
Country	:	US
Telephone Number	:	865-305-9799
Fax Number	:

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

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	01/23/2026

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