Provider Demographics
NPI:1215639745
Name:JAMES, MAKENZIE
Entity type:Individual
Prefix:MRS
First Name:MAKENZIE
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MAKENZIE
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2591 MILLERSBURG DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-9504
Mailing Address - Country:US
Mailing Address - Phone:541-556-5424
Mailing Address - Fax:
Practice Address - Street 1:2591 MILLERSBURG DR NE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-9504
Practice Address - Country:US
Practice Address - Phone:541-556-5424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant