Provider Demographics
NPI:1245968049
Name:AARON, MCKENSIE CLARK (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MCKENSIE
Middle Name:CLARK
Last Name:AARON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 BONITA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-1164
Mailing Address - Country:US
Mailing Address - Phone:251-508-6047
Mailing Address - Fax:
Practice Address - Street 1:1707 BONITA AVE APT 1
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1164
Practice Address - Country:US
Practice Address - Phone:251-508-6047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9435917163W00000X
AL1-182878163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse