Provider Demographics
NPI:1417144072
Name:MCKENZIE, TONYA RENELL (APRN-BC)
Entity Type:Individual
Prefix:MISS
First Name:TONYA
Middle Name:RENELL
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8834
Mailing Address - Country:US
Mailing Address - Phone:843-349-6543
Mailing Address - Fax:843-349-6546
Practice Address - Street 1:204 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8834
Practice Address - Country:US
Practice Address - Phone:843-349-6543
Practice Address - Fax:843-349-6546
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 1625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily