Provider Demographics
NPI:1053752626
Name:MCKENZIE, KRISTIN DIANE (DNP, BSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DIANE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:DNP, BSN, PMHNP-BC
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3055 SOUTHWESTERN BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1231
Mailing Address - Country:US
Mailing Address - Phone:716-903-6036
Mailing Address - Fax:716-463-2225
Practice Address - Street 1:3055 SOUTHWESTERN BLVD STE 110
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1231
Practice Address - Country:US
Practice Address - Phone:716-903-6036
Practice Address - Fax:716-463-2225
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY562312163W00000X
NY401631363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse