Provider Demographics
NPI:1003898214
Name:MCKENZIE, DONALD HUGH JR (PA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:HUGH
Last Name:MCKENZIE
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-334-8700
Mailing Address - Fax:859-334-8707
Practice Address - Street 1:1980 LITTON LANE
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-8669
Practice Address - Country:US
Practice Address - Phone:859-334-8700
Practice Address - Fax:859-334-8707
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-002510363A00000X
IN01073032A363A00000X
IN10001943A363A00000X
KYTC-029363AM0700X
KYPA1134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM49025006Medicare PIN