Provider Demographics
NPI:1437668068
Name:MCKENZIE-COODY, KRISTI ANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:ANNE
Last Name:MCKENZIE-COODY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 740429
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32774-0429
Mailing Address - Country:US
Mailing Address - Phone:386-804-3626
Mailing Address - Fax:
Practice Address - Street 1:744 E RHODE ISLAND AVE STE B
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-6609
Practice Address - Country:US
Practice Address - Phone:386-804-3626
Practice Address - Fax:386-804-3626
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9390006363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily