Provider Demographics
NPI:1215671813
Name:LAVENGCO, MCKENZIE ELISE (PA-C)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:ELISE
Last Name:LAVENGCO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:915 ENCHANTED OAK DR
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-4250
Mailing Address - Country:US
Mailing Address - Phone:713-213-6743
Mailing Address - Fax:
Practice Address - Street 1:13830 SAWYER RANCH RD STE 302
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5514
Practice Address - Country:US
Practice Address - Phone:512-894-2294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant