Provider Demographics
NPI:1205193240
Name:MCKENZIE, JENNIFER LOUISE (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOUISE
Last Name:MCKENZIE
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 1:4125 STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-4423
Mailing Address - Country:US
Mailing Address - Phone:816-908-9739
Mailing Address - Fax:816-908-9738
Practice Address - Street 1:19550 E 39TH ST S STE 110
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2353
Practice Address - Country:US
Practice Address - Phone:816-698-8900
Practice Address - Fax:816-698-8905
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012014779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily