Provider Demographics
NPI:1740365493
Name:MCKENZIE, SHIRLEY BECTON (PPCNP-BC)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:BECTON
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PPCNP-BC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:401 CARPENTER RD BLDG 525
Mailing Address - Street 2:1015
Mailing Address - City:FORT MYER
Mailing Address - State:VA
Mailing Address - Zip Code:22211-1009
Mailing Address - Country:US
Mailing Address - Phone:833-853-1392
Mailing Address - Fax:703-696-9248
Practice Address - Street 1:401 CARPENTER RD BLDG 525
Practice Address - Street 2:1015
Practice Address - City:FORT MYER
Practice Address - State:VA
Practice Address - Zip Code:22211-1009
Practice Address - Country:US
Practice Address - Phone:703-696-3614
Practice Address - Fax:703-696-9248
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0017141236363LP0200X
VA0024171110363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA02807327Medicaid
CO02807327Medicaid
COCOA103053Medicare PIN