Provider Demographics
NPI:1063029486
Name:DURRANT, MAKENSEY BETH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MAKENSEY
Middle Name:BETH
Last Name:DURRANT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5518 E HARMONY AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6756
Mailing Address - Country:US
Mailing Address - Phone:801-899-5539
Mailing Address - Fax:
Practice Address - Street 1:1684 E BOSTON ST STE 102
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6220
Practice Address - Country:US
Practice Address - Phone:480-448-2411
Practice Address - Fax:480-476-8718
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ247003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily