Provider Demographics
NPI:1215701511
Name:MCKENZIE, JACIE (PA-C)
Entity type:Individual
Prefix:
First Name:JACIE
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HIGH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-8638
Mailing Address - Country:US
Mailing Address - Phone:601-441-0032
Mailing Address - Fax:
Practice Address - Street 1:9985 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-9525
Practice Address - Country:US
Practice Address - Phone:351-633-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant