Provider Demographics
NPI:1912518549
Name:MCCONNELL, MAKENZIE DUNNING
Entity type:Individual
Prefix:MRS
First Name:MAKENZIE
Middle Name:DUNNING
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:ROSE-LYNN
Other - Last Name:DUNNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6505 HERITAGE TRACE CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-6209
Mailing Address - Country:US
Mailing Address - Phone:251-656-6431
Mailing Address - Fax:
Practice Address - Street 1:2841 LEIGH CT
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-9794
Practice Address - Country:US
Practice Address - Phone:251-656-6431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-17
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL1838363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program