Provider Demographics
NPI:1003436585
Name:ABBOTT, MAKENZIE LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:LYNN
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1014 MADISON ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65101-3458
Practice Address - Country:US
Practice Address - Phone:573-644-6999
Practice Address - Fax:573-644-7880
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2025-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2020007089363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant