Provider Demographics
NPI:1891415345
Name:MCKENZIE, TAYLA (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAYLA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1001 HIGHWAY 411 N
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37331-1906
Mailing Address - Country:US
Mailing Address - Phone:423-604-4664
Mailing Address - Fax:423-604-4665
Practice Address - Street 1:1001 HIGHWAY 411 N
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-1906
Practice Address - Country:US
Practice Address - Phone:423-604-4664
Practice Address - Fax:423-604-4665
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
TN5140363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical