Provider Demographics
NPI:1760184832
Name:CONLEY, MCKENZIE JORDAN
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:JORDAN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:JORDAN
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9004 S SHARTEL AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-5103
Mailing Address - Country:US
Mailing Address - Phone:970-692-9812
Mailing Address - Fax:
Practice Address - Street 1:220 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3902
Practice Address - Country:US
Practice Address - Phone:405-815-7162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-21
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist