Provider Demographics
NPI:1427634997
Name:MCKENZIE, JESIKA
Entity type:Individual
Prefix:
First Name:JESIKA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:JESIKA
Other - Middle Name:
Other - Last Name:MCKENZIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10142 W GROSS AVE
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-1204
Mailing Address - Country:US
Mailing Address - Phone:602-550-8795
Mailing Address - Fax:
Practice Address - Street 1:13555 W MCDOWELL RD STE 205
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2626
Practice Address - Country:US
Practice Address - Phone:602-550-8795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN212813163WP0808X
AZ260601363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health