Provider Demographics
NPI:1245739564
Name:MCKENZIE, MEGAN MORTON (FNP-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MORTON
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-1915
Mailing Address - Country:US
Mailing Address - Phone:615-318-1220
Mailing Address - Fax:615-318-1159
Practice Address - Street 1:101 W BROAD ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-1915
Practice Address - Country:US
Practice Address - Phone:615-318-1220
Practice Address - Fax:615-318-1159
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136351363L00000X, 363LF0000X
TN33869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner