Provider Demographics
NPI:1528874492
Name:MCKENZIE, KAMERON ELIZABETH (RN, IHP)
Entity type:Individual
Prefix:
First Name:KAMERON
Middle Name:ELIZABETH
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:RN, IHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19273 E ROUND MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-6573
Mailing Address - Country:US
Mailing Address - Phone:417-296-4472
Mailing Address - Fax:
Practice Address - Street 1:19273 E ROUND MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-6573
Practice Address - Country:US
Practice Address - Phone:417-296-4472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK212735163W00000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No163W00000XNursing Service ProvidersRegistered Nurse