Doctor Name: | KAREN LEE MACKENNEY |
NPI Number: | 1003014366 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, FNP |
License Number: | 564482 |
Business Practice Address: | 135 Vision Park Blvd Shenandoah, TX - 773843001 |
Business Phone Number: | 2814043000 |
Business Fax Number: | 2812909824 |
Mailing Address: | 135 Vision Park Blvd, SHENANDOAH |
State: | TX |
Postal Code: | 773843001 |
Phone Number: | 2814043000 |
Fax Number: | 2812909824 |
NPI Enumeration Date: | 07/10/2007 |
NPI Last Update Date: | 01/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 564482 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |