Provider Demographics
NPI:1124865118
Name:LEDBETTER, MACKENZIE THOMAS (FNP-C)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:THOMAS
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:THOMAS
Other - Last Name:LEDBETTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:815 LEE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-2882
Mailing Address - Country:US
Mailing Address - Phone:256-212-9300
Mailing Address - Fax:256-212-9363
Practice Address - Street 1:815 LEE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-2882
Practice Address - Country:US
Practice Address - Phone:256-212-9300
Practice Address - Fax:256-212-9363
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-100396363LF0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily