Provider Demographics
NPI:1740053370
Name:MCKENZIE, KELLY J (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 N WRENS WAY
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-2465
Mailing Address - Country:US
Mailing Address - Phone:845-428-0082
Mailing Address - Fax:
Practice Address - Street 1:78 N WRENS WAY
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952-2465
Practice Address - Country:US
Practice Address - Phone:845-428-0082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0047985163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant