Provider Demographics
NPI:1386315158
Name:BAKKEN, MADISON MCKENZIE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:MADISON
Middle Name:MCKENZIE
Last Name:BAKKEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-713-8250
Mailing Address - Fax:336-713-8252
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-5450
Practice Address - Country:US
Practice Address - Phone:336-713-8250
Practice Address - Fax:336-713-8252
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCBAKK-N6SJJ363LF0000X
MARN2381719363LF0000X
NC5015099363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily