Provider Demographics
NPI:1962100974
Name:DOHERTY, MACKENZIE HILL (NP)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:HILL
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:7602 DANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-7926
Mailing Address - Country:US
Mailing Address - Phone:256-318-9189
Mailing Address - Fax:
Practice Address - Street 1:200 CARRAWAY DR
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594-5072
Practice Address - Country:US
Practice Address - Phone:205-487-7556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-166569363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics