Provider Demographics
NPI:1134688039
Name:MCKENZIE, SARA ANNE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:ANNE MARIE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308 E HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:SALT LICK
Mailing Address - State:KY
Mailing Address - Zip Code:40371-8767
Mailing Address - Country:US
Mailing Address - Phone:606-207-2645
Mailing Address - Fax:
Practice Address - Street 1:3576 PIMLICO PKWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3700
Practice Address - Country:US
Practice Address - Phone:606-207-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05639207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine