Provider Demographics
NPI:1760184832
Name:CONLEY, MCKENZIE JORDAN
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:JORDAN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:JORDAN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5221 NW 111TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-3713
Mailing Address - Country:US
Mailing Address - Phone:970-692-9812
Mailing Address - Fax:
Practice Address - Street 1:24962 OKAY RD
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873-6504
Practice Address - Country:US
Practice Address - Phone:405-253-2020
Practice Address - Fax:405-598-8227
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist