Provider Demographics
NPI:1073165544
Name:KINDER, MAKENZIE (MSPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:KINDER
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:
Other - Last Name:WALTERMIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 COMMERCE CIR
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-7815
Mailing Address - Country:US
Mailing Address - Phone:859-498-5243
Mailing Address - Fax:859-498-5396
Practice Address - Street 1:401 COMMERCE CIR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-7815
Practice Address - Country:US
Practice Address - Phone:859-498-5243
Practice Address - Fax:859-498-5396
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2563363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant