| Doctor Name: | MARY MCKENZIE |
| NPI Number: | 1013012509 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | 556727 |
| Business Practice Address: | 2021 W Loop 281 Longview, TX - 756042504 |
| Business Phone Number: | 9032951396 |
| Business Fax Number: | |
| Mailing Address: | Po Box 847176, DALLAS |
| State: | TX |
| Postal Code: | 752847176 |
| Phone Number: | 9032371800 |
| Fax Number: | 9032371810 |
| NPI Enumeration Date: | 09/13/2006 |
| NPI Last Update Date: | 09/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 556727 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |