Provider Demographics
NPI:1902690290
Name:HERNANDEZ, MCKENZIE KELIS
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:KELIS
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3973 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-4112
Mailing Address - Country:US
Mailing Address - Phone:432-307-0203
Mailing Address - Fax:
Practice Address - Street 1:23 HOSPITAL DR. SUITE 102
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606
Practice Address - Country:US
Practice Address - Phone:325-238-9337
Practice Address - Fax:325-238-9337
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician