Provider Demographics
NPI:1134876535
Name:BARTLETT, MCKENZIE LYNN (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:LYNN
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:31792 HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-3452
Mailing Address - Country:US
Mailing Address - Phone:281-253-4833
Mailing Address - Fax:
Practice Address - Street 1:1709 MARTIN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086
Practice Address - Country:US
Practice Address - Phone:817-783-9973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-05
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant