Provider Demographics
NPI:1467889188
Name:SMITH, MACKENZI KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:MACKENZI
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3310
Mailing Address - Country:US
Mailing Address - Phone:605-668-8805
Mailing Address - Fax:605-668-9448
Practice Address - Street 1:1115 W 9TH ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3310
Practice Address - Country:US
Practice Address - Phone:605-668-8805
Practice Address - Fax:605-668-9448
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002448363A00000X
SD1253363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant