Provider Demographics
NPI:1689485914
Name:YOUNG, MACKENZIE
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 DAVIO PL
Mailing Address - Street 2:
Mailing Address - City:WEST GLOVER
Mailing Address - State:VT
Mailing Address - Zip Code:05875-9324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:297 DAVIO PL
Practice Address - Street 2:
Practice Address - City:WEST GLOVER
Practice Address - State:VT
Practice Address - Zip Code:05875-9324
Practice Address - Country:US
Practice Address - Phone:802-673-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant