Provider Demographics
NPI:1235837733
Name:LOOS, MCKENZIE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:ANN
Last Name:LOOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:ANN
Other - Last Name:LOOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-9124
Mailing Address - Fax:336-716-9188
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2580
Practice Address - Fax:336-716-5324
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12995207RC0000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease