Provider Demographics
NPI:1033808910
Name:EDWARDS, MACKENZIE ELIZABETH
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:ELIZABETH
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 NE CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1957
Mailing Address - Country:US
Mailing Address - Phone:816-674-7164
Mailing Address - Fax:
Practice Address - Street 1:2330 E MEYER BLVD STE T411
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1162
Practice Address - Country:US
Practice Address - Phone:816-363-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023007123363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner