Provider Demographics
NPI:1699098749
Name:MCKENZIE, PATRICK DOUGLAS (RN, BSN, MSN, FNP-C)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:DOUGLAS
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:RN, BSN, MSN, FNP-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:2114 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1853
Mailing Address - Country:US
Mailing Address - Phone:707-426-2239
Mailing Address - Fax:
Practice Address - Street 1:4700 NORTHGATE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1128
Practice Address - Country:US
Practice Address - Phone:916-929-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA296107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily