Provider Demographics
NPI:1235849043
Name:ATKINSON, MCKENZIE (MPA, PA)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:MPA, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 GLEN FOREST DR STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-662-6138
Mailing Address - Fax:
Practice Address - Street 1:12129 GRAHAM MEADOWS DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23233-6661
Practice Address - Country:US
Practice Address - Phone:804-288-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110009366363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant