Provider Demographics
NPI:1255387544
Name:MCKENZIE, TRINITY (MD)
Entity type:Individual
Prefix:
First Name:TRINITY
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5446 HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MS
Mailing Address - Zip Code:39645-7237
Mailing Address - Country:US
Mailing Address - Phone:601-657-1113
Mailing Address - Fax:
Practice Address - Street 1:1410 MAIN STREET EAST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MS
Practice Address - Zip Code:39645-0514
Practice Address - Country:US
Practice Address - Phone:601-657-8820
Practice Address - Fax:601-657-9091
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19138207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BM9540508OtherDEA #