Provider Demographics
NPI:1114661303
Name:BOATRIGHT, MARY-KATHERINE MCKENZIE (NP-C)
Entity Type:Individual
Prefix:
First Name:MARY-KATHERINE
Middle Name:MCKENZIE
Last Name:BOATRIGHT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 RIVERMIST RD
Mailing Address - Street 2:
Mailing Address - City:JULIETTE
Mailing Address - State:GA
Mailing Address - Zip Code:31046-3608
Mailing Address - Country:US
Mailing Address - Phone:912-402-9160
Mailing Address - Fax:
Practice Address - Street 1:556 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7993
Practice Address - Country:US
Practice Address - Phone:478-743-2472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN284149363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner