Provider Demographics
NPI:1912529009
Name:MCKENZIE, LESIA B (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LESIA
Middle Name:B
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3394 YOUNG CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-8272
Mailing Address - Country:US
Mailing Address - Phone:843-624-8098
Mailing Address - Fax:
Practice Address - Street 1:3394 YOUNG CHARLES DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8272
Practice Address - Country:US
Practice Address - Phone:843-624-8098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93302163W00000X
SC24090363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
93302OtherNURSING LICENSE
SC93302OtherNURSING LICENSE