Provider Demographics
NPI:1891524773
Name:MCKENZIE, ALYSSA (CPM)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 S HUDSON PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-3753
Mailing Address - Country:US
Mailing Address - Phone:682-262-5805
Mailing Address - Fax:
Practice Address - Street 1:2320 S HUDSON PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3753
Practice Address - Country:US
Practice Address - Phone:682-262-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife