Provider Demographics
NPI:1073079190
Name:HARDEN, MCKENZIE K (PA-C)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:K
Last Name:HARDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-7499
Mailing Address - Fax:614-366-2360
Practice Address - Street 1:410 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-7499
Practice Address - Fax:614-366-2360
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005879X363A00000X
OH50.005879RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant