Provider Demographics
NPI:1396419180
Name:JONES, MCKENZIE RAE (APRN)
Entity Type:Individual
Prefix:MS
First Name:MCKENZIE
Middle Name:RAE
Last Name:JONES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:MCKENZIE
Other - Middle Name:RAE
Other - Last Name:JONES NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3911 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-5439
Mailing Address - Country:US
Mailing Address - Phone:402-499-1335
Mailing Address - Fax:
Practice Address - Street 1:2130 S 17TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3750
Practice Address - Country:US
Practice Address - Phone:402-454-7454
Practice Address - Fax:888-490-1927
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113629363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health