Provider Demographics
NPI:1679172787
Name:MCKENZIE, SHELLI M (NP-C)
Entity type:Individual
Prefix:MRS
First Name:SHELLI
Middle Name:M
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SHELLI
Other - Middle Name:M
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:888-973-8821
Practice Address - Street 1:3200 W END AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1330
Practice Address - Country:US
Practice Address - Phone:866-849-0692
Practice Address - Fax:888-973-8821
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0037016363L00000X
TX1171272363L00000X
TN28738363L00000X
COC-APN.0103447-C-NP363L00000X
FLAPRN11037194363L00000X
GARN189722363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty