Provider Demographics
NPI:1124388103
Name:HINSHAW, MCKENZIE L (NP)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:L
Last Name:HINSHAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47348-1365
Mailing Address - Country:US
Mailing Address - Phone:765-348-1100
Mailing Address - Fax:765-348-9717
Practice Address - Street 1:2005 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:HARTFORD CITY
Practice Address - State:IN
Practice Address - Zip Code:47348-1365
Practice Address - Country:US
Practice Address - Phone:765-348-1100
Practice Address - Fax:765-348-9717
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN363L00000X363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201066380Medicaid