Provider Demographics
NPI:1770156754
Name:BARNARD, MACKENZIE MAUREEN (APRN-NP)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:MAUREEN
Last Name:BARNARD
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-1563
Mailing Address - Country:US
Mailing Address - Phone:402-709-7856
Mailing Address - Fax:
Practice Address - Street 1:2207 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4524
Practice Address - Country:US
Practice Address - Phone:402-734-4110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113688363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care