Provider Demographics
NPI:1386129856
Name:MCKENZIE, LYDIA ANNE (DNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANNE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03570-1845
Mailing Address - Country:US
Mailing Address - Phone:603-287-4186
Mailing Address - Fax:603-945-7107
Practice Address - Street 1:13 TOWN WEST RD STE B3
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3428
Practice Address - Country:US
Practice Address - Phone:603-945-8048
Practice Address - Fax:603-945-7110
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH079038-23363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3114801Medicaid
VT1034114Medicaid