Basic Information
| Provider Information | |||||||||
| NPI: | 1811946346 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKENZIE | ||||||||
| FirstName: | KRISTI | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1720 NICHOLASVILLE RD | ||||||||
| Address2: | SUITE 702 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592648811 | ||||||||
| FaxNumber: | 8592648822 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 NICHOLASVILLE RD | ||||||||
| Address2: | SUITE 702 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592648811 | ||||||||
| FaxNumber: | 8592648822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 11/17/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 39414 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 4000501 | 01 | KY | MEDICARE LAB GROUP | OTHER | 64100191 | 05 | KY | MEDICAID | 37903705 | 01 | KY | MEDICAID LAB GROUP | OTHER |