Provider Demographics
NPI:1568956670
Name:WYLIE, MCKENZIE ELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:MCKENZIE
Middle Name:ELLE
Last Name:WYLIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MCKENZIE
Other - Middle Name:ELLE
Other - Last Name:WYLIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:5100 N TOWNE CENTRE DR
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7479
Practice Address - Country:US
Practice Address - Phone:417-269-2215
Practice Address - Fax:417-269-2427
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021010687207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine