Provider Demographics
NPI:1619093879
Name:MCKENZIE, KERRY LEE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KERRY
Middle Name:LEE
Last Name:MCKENZIE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1208 HILLTOP DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5857
Mailing Address - Country:US
Mailing Address - Phone:307-352-8199
Mailing Address - Fax:307-352-8148
Practice Address - Street 1:1204 HILLTOP DR
Practice Address - Street 2:SUITE 108
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5861
Practice Address - Country:US
Practice Address - Phone:307-352-8125
Practice Address - Fax:307-352-8126
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2012-08-24
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Provider Licenses
StateLicense IDTaxonomies
WY166363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant