Provider Demographics
NPI:1598146433
Name:EBERLY, MACKENZI (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MACKENZI
Middle Name:
Last Name:EBERLY
Suffix:
Gender:F
Credentials:FNP-C
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 2088
Mailing Address - Street 2:
Mailing Address - City:SHALLOWATER
Mailing Address - State:TX
Mailing Address - Zip Code:79363-2088
Mailing Address - Country:US
Mailing Address - Phone:806-832-4566
Mailing Address - Fax:068-324-1438
Practice Address - Street 1:1502 12TH ST STE A
Practice Address - Street 2:
Practice Address - City:SHALLOWATER
Practice Address - State:TX
Practice Address - Zip Code:79363-5651
Practice Address - Country:US
Practice Address - Phone:806-832-4566
Practice Address - Fax:806-832-4143
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily