Provider Demographics
NPI:1912681123
Name:MCKENZIE, LESLI JOHNELL (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LESLI
Middle Name:JOHNELL
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:MRS
Other - First Name:LESLI
Other - Middle Name:JOHNELL
Other - Last Name:MCFARLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN AND RN
Mailing Address - Street 1:3201 S AUSTIN AVE STE 255
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7644
Mailing Address - Country:US
Mailing Address - Phone:512-501-4287
Mailing Address - Fax:512-651-8444
Practice Address - Street 1:3201 S AUSTIN AVE STE 255
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7644
Practice Address - Country:US
Practice Address - Phone:512-501-4287
Practice Address - Fax:512-651-8444
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1124908363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily