Provider Demographics
NPI:1467234070
Name:HART, KENZIE VICTORIA (PA-C)
Entity type:Individual
Prefix:
First Name:KENZIE
Middle Name:VICTORIA
Last Name:HART
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KENZIE
Other - Middle Name:VICTORIA
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4300 W MEMORIAL RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8304
Mailing Address - Country:US
Mailing Address - Phone:405-752-3715
Mailing Address - Fax:405-936-5058
Practice Address - Street 1:4300 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8304
Practice Address - Country:US
Practice Address - Phone:405-752-3715
Practice Address - Fax:405-936-5058
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5122363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant