Provider Demographics
NPI:1588549315
Name:HENRY, MCKENZIE TAYLOR
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:TAYLOR
Last Name:HENRY
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 1:3160 MISER STATION RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37777-3603
Mailing Address - Country:US
Mailing Address - Phone:865-253-3559
Mailing Address - Fax:
Practice Address - Street 1:3160 MISER STATION RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:TN
Practice Address - Zip Code:37777-3603
Practice Address - Country:US
Practice Address - Phone:865-253-3559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant