1710583059 NPI number — MACKENZIE ALEXANDRA KENDRICK APRN,NP-C

Table of content: MACKENZIE ALEXANDRA KENDRICK APRN,NP-C (NPI 1710583059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710583059 NPI number — MACKENZIE ALEXANDRA KENDRICK APRN,NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENDRICK
Provider First Name:
MACKENZIE
Provider Middle Name:
ALEXANDRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN,NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HORTENSTINE
Provider Other First Name:
MACKENZIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710583059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 211699
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGAN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55121-3699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-849-0692
Provider Business Mailing Address Fax Number:
888-973-8821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 W END AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-1330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-849-0692
Provider Business Practice Location Address Fax Number:
888-973-8821
Provider Enumeration Date:
12/10/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  3-001678 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 28091 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 11031774 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)