Provider Demographics
NPI:1699562389
Name:IKENBERRY, MACKENZIE KEIR (MS CGC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:KEIR
Last Name:IKENBERRY
Suffix:
Gender:
Credentials:MS CGC
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:KEIR
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:874 LOWERY DR NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-3000
Mailing Address - Country:US
Mailing Address - Phone:360-840-0432
Mailing Address - Fax:
Practice Address - Street 1:5153 N 9TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-5719
Practice Address - Country:US
Practice Address - Phone:850-416-2453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS