Provider Demographics
NPI:1194281931
Name:TAYLOR, MACKENZIE K (NP)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:K
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 BROAD AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-2460
Mailing Address - Country:US
Mailing Address - Phone:228-867-4855
Mailing Address - Fax:
Practice Address - Street 1:2911 MEDICAL ARTS ST STE 10
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3302
Practice Address - Country:US
Practice Address - Phone:866-473-0663
Practice Address - Fax:866-473-9370
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903145363L00000X
TX1115452363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner