1144947904 NPI number — MRS. MAKENZIE ANN MCKERNAN WHNP

Table of content: MRS. MAKENZIE ANN MCKERNAN WHNP (NPI 1144947904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144947904 NPI number — MRS. MAKENZIE ANN MCKERNAN WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCKERNAN
Provider First Name:
MAKENZIE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINSLOW
Provider Other First Name:
MAKENZIE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
WHNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144947904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 THIRD STREET AHMC OB/GYN & MIDWIFERY
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
MALONE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-481-2896
Provider Business Mailing Address Fax Number:
518-481-2895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 THIRD STREET UVMHN ALICE HYDE MEDICAL CENTER OB/GYN
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
MALONE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-481-2896
Provider Business Practice Location Address Fax Number:
518-481-2895
Provider Enumeration Date:
10/24/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  026.0142363 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 421700 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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