Provider Demographics
NPI:1144858515
Name:KIRCHNER, MACKENZIE ANNA (PA)
Entity type:Individual
Prefix:MS
First Name:MACKENZIE
Middle Name:ANNA
Last Name:KIRCHNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:568 SANDY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4205
Mailing Address - Country:US
Mailing Address - Phone:810-618-1141
Mailing Address - Fax:
Practice Address - Street 1:568 SANDY CREEK RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4205
Practice Address - Country:US
Practice Address - Phone:810-618-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant