Provider Demographics
NPI:1073079190
Name:HARDEN, MCKENZIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:HARDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:96 INTEGRITY DR STE H
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:OH
Mailing Address - Zip Code:43025-7013
Mailing Address - Country:US
Mailing Address - Phone:220-564-2100
Mailing Address - Fax:220-564-2101
Practice Address - Street 1:96 INTEGRITY DR STE H
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:OH
Practice Address - Zip Code:43025-7013
Practice Address - Country:US
Practice Address - Phone:220-564-2100
Practice Address - Fax:220-564-2101
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005879RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical