Provider Demographics
NPI:1003351727
Name:ROBERTS, MACKENZIE KREBSBACH (CRNP)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:KREBSBACH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:NICOLE
Other - Last Name:KREBSBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1355
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-1355
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2451 UNIVERSITY HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2300
Practice Address - Country:US
Practice Address - Phone:251-471-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-138001363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care