Provider Demographics
NPI:1568050177
Name:LAWSON, MACKENZIE D (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:D
Last Name:LAWSON
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:D
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPAS
Mailing Address - Street 1:6983 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2054
Mailing Address - Country:US
Mailing Address - Phone:317-849-8350
Mailing Address - Fax:317-576-6311
Practice Address - Street 1:1030 E COUNTY LINE RD STE B1
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2933
Practice Address - Country:US
Practice Address - Phone:317-746-6876
Practice Address - Fax:317-222-4931
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002664A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical