Provider Demographics
NPI:1053335059
Name:MCKENZIE, HEATHER L (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 SOUTH FWY STE 302
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7215
Mailing Address - Country:US
Mailing Address - Phone:817-854-2210
Mailing Address - Fax:833-963-2128
Practice Address - Street 1:12001 SOUTH FWY STE 302
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7215
Practice Address - Country:US
Practice Address - Phone:817-854-2210
Practice Address - Fax:833-963-2128
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A1143OtherBCBS
TX182926904Medicaid
TX8L5147Medicare PIN