Provider Demographics
NPI:1114748894
Name:JONES, MACKENZIE SHAE LIEDEL
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:SHAE LIEDEL
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MIDDLE CREEK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5056
Mailing Address - Country:US
Mailing Address - Phone:865-908-9888
Mailing Address - Fax:865-908-8756
Practice Address - Street 1:740 MIDDLE CREEK RD STE 200
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5056
Practice Address - Country:US
Practice Address - Phone:865-908-9888
Practice Address - Fax:865-908-8756
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37423363L00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner