Basic Information
| Provider Information | |||||||||
| NPI: | 1962754440 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCKENZIE | ||||||||
| FirstName: | KAYLA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 102 BELLWOOD CT | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272829446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173290363 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1915 LENDEW ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362753325 | ||||||||
| FaxNumber: | 3362755346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2012 | ||||||||
| LastUpdateDate: | 02/13/2013 | ||||||||
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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 | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.