Provider Demographics
NPI:1699420240
Name:COLEMAN, MACKENZIE LAYNE (PA-C)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:LAYNE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3102 RIVER SHORE PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4894
Mailing Address - Country:US
Mailing Address - Phone:317-441-2207
Mailing Address - Fax:
Practice Address - Street 1:1234 NAPIER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2112
Practice Address - Country:US
Practice Address - Phone:269-985-4632
Practice Address - Fax:269-985-4523
Is Sole Proprietor?:No
Enumeration Date:2022-02-12
Last Update Date:2023-05-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant