Provider Demographics
NPI:1437788981
Name:MCFADDEN, KENZIE (MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:KENZIE
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75147-7301
Mailing Address - Country:US
Mailing Address - Phone:903-326-1825
Mailing Address - Fax:
Practice Address - Street 1:1703 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147-7301
Practice Address - Country:US
Practice Address - Phone:903-326-1825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1030288363L00000X
TX878298163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WE0003XNursing Service ProvidersRegistered NurseEmergency