Provider Demographics
NPI:1194249763
Name:MCMANUS, MCKENZIE S (NP-C)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:S
Last Name:MCMANUS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 WOLFLIN AVE # 968
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1825
Mailing Address - Country:US
Mailing Address - Phone:806-351-2000
Mailing Address - Fax:806-351-2060
Practice Address - Street 1:2701 S GEORGIA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1979
Practice Address - Country:US
Practice Address - Phone:806-351-2000
Practice Address - Fax:806-351-2060
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN270565363LF0000X
TX1013902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily