Provider Demographics
NPI:1427680750
Name:HALE, MCKENZI (PA)
Entity type:Individual
Prefix:
First Name:MCKENZI
Middle Name:
Last Name:HALE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 SAINT MICHAELS DR BLDG SUITE107
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7670
Mailing Address - Country:US
Mailing Address - Phone:505-913-4271
Mailing Address - Fax:505-913-3562
Practice Address - Street 1:465 SAINT MICHAELS DR BLDG SUITE107
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7670
Practice Address - Country:US
Practice Address - Phone:505-913-4271
Practice Address - Fax:505-913-3562
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant