Provider Demographics
NPI:1831143072
Name:MACKENZIE, REBECCA L (CFNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-4152
Mailing Address - Country:US
Mailing Address - Phone:865-908-0400
Mailing Address - Fax:865-453-7009
Practice Address - Street 1:435 PARKWAY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-4152
Practice Address - Country:US
Practice Address - Phone:865-908-0400
Practice Address - Fax:865-453-7009
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000110816363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner