Provider Demographics
NPI:1992458046
Name:HENDRICKS, MACKENZIE B
Entity type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:B
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S CORDER RD APT 817
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5719
Mailing Address - Country:US
Mailing Address - Phone:478-335-3178
Mailing Address - Fax:
Practice Address - Street 1:410 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-3097
Practice Address - Country:US
Practice Address - Phone:478-825-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-29
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program