Provider Demographics
NPI:1346983327
Name:MCKENZIE, KELLY JANEL (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JANEL
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:435 N MULFORD RD STE 9
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5100
Mailing Address - Country:US
Mailing Address - Phone:815-229-1700
Mailing Address - Fax:815-229-1831
Practice Address - Street 1:2010 S ARLINGTON HEIGHTS RD STE 240
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4147
Practice Address - Country:US
Practice Address - Phone:815-229-1700
Practice Address - Fax:815-229-1831
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209024948363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner