Provider Demographics
NPI:1811360381
Name:LAMB, MACKENZIE KAY (PA-C)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:KAY
Last Name:LAMB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 NE CUMULUS AVE
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8805
Mailing Address - Country:US
Mailing Address - Phone:503-472-6161
Mailing Address - Fax:
Practice Address - Street 1:2435 NE CUMULUS AVE
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8805
Practice Address - Country:US
Practice Address - Phone:503-472-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA174877363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant