Provider Demographics
NPI:1619593597
Name:KUSGEN, MCKENZIE JO (NP-C)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:JO
Last Name:KUSGEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20500 HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:BLACKWATER
Mailing Address - State:MO
Mailing Address - Zip Code:65322-2245
Mailing Address - Country:US
Mailing Address - Phone:660-619-3551
Mailing Address - Fax:
Practice Address - Street 1:3700 W 10TH ST STE 200
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2540
Practice Address - Country:US
Practice Address - Phone:660-827-1771
Practice Address - Fax:660-827-1422
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020016688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily