Provider Demographics
NPI:1033552534
Name:MACKENZIE, KELSIE MICHELLE (PNP-AC)
Entity Type:Individual
Prefix:MISS
First Name:KELSIE
Middle Name:MICHELLE
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:PNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7046 SW ARCHER RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4723
Mailing Address - Country:US
Mailing Address - Phone:352-733-1770
Mailing Address - Fax:
Practice Address - Street 1:7046 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4723
Practice Address - Country:US
Practice Address - Phone:352-733-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006157363LP0222X
FLARNP9391902363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013948500Medicaid
FLIB587YMedicare PIN