Provider Demographics
NPI:1245273796
Name:MCKENZIE, JENNIFER C (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:MCKENZIE
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 1:1206 HIGHWAY 411
Mailing Address - Street 2:
Mailing Address - City:VONORE
Mailing Address - State:TN
Mailing Address - Zip Code:37885-2455
Mailing Address - Country:US
Mailing Address - Phone:423-442-2622
Mailing Address - Fax:423-442-5760
Practice Address - Street 1:1206 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:VONORE
Practice Address - State:TN
Practice Address - Zip Code:37885-2455
Practice Address - Country:US
Practice Address - Phone:423-442-2622
Practice Address - Fax:423-442-5760
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6837363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3070114OtherBLUE CROSS BLUE SHIELD #
TN3344266Medicaid
TN1507391Medicaid
TN3344267Medicaid
TN3344266Medicaid
TN3344266Medicare PIN
TN3344267Medicare PIN
TNS43326Medicare UPIN