Provider Demographics
NPI:1023248200
Name:MCKENZIE, ANNABELLE ANNETTE (CRNA)
Entity type:Individual
Prefix:
First Name:ANNABELLE
Middle Name:ANNETTE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANNABELLE
Other - Middle Name:ANNETTE
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:1500 CITYWEST BLVD STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2549
Practice Address - Country:US
Practice Address - Phone:713-640-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2020-08-25
Deactivation Date:2018-08-06
Deactivation Code:
Reactivation Date:2018-08-14
Provider Licenses
StateLicense IDTaxonomies
TX693902367500000X
TXAP118816367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2163469Medicaid
TX8127UAOtherBLUE CROSS BLUE SHIELD
TX211622001Medicaid
LA2163469Medicaid