Provider Demographics
NPI:1003014366
Name:MACKENNEY, KAREN LEE (RN, FNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:MACKENNEY
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 VISION PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3001
Mailing Address - Country:US
Mailing Address - Phone:281-404-3000
Mailing Address - Fax:281-290-9824
Practice Address - Street 1:135 VISION PARK BLVD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3001
Practice Address - Country:US
Practice Address - Phone:281-404-3000
Practice Address - Fax:281-290-9824
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564482363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206017002Medicaid
TXTXB140990Medicare PIN