Provider Demographics
NPI:1831498534
Name:SKELTON, MACKENZIE LEE (FNP)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LEE
Last Name:SKELTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 S COULTER ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1758
Mailing Address - Country:US
Mailing Address - Phone:806-355-9741
Mailing Address - Fax:806-677-7614
Practice Address - Street 1:1215 S COULTER ST
Practice Address - Street 2:SUITE 301
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1758
Practice Address - Country:US
Practice Address - Phone:806-355-9741
Practice Address - Fax:806-677-7614
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737528363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily