Provider Demographics
NPI:1912597675
Name:DAVIS, MCKENZIE BROOKE (PA-C)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:BROOKE
Last Name:DAVIS
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 1:800 E SPRING ST APT NN2
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4508
Mailing Address - Country:US
Mailing Address - Phone:931-239-5239
Mailing Address - Fax:
Practice Address - Street 1:1120 PERIMETER PARK DR
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0922
Practice Address - Country:US
Practice Address - Phone:931-528-0002
Practice Address - Fax:931-528-1515
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000004507363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical