Provider Demographics
NPI:1063962611
Name:DAVIS, MACKENZIE JEANNE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JEANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8841 SIX FORKS RD # 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2970
Mailing Address - Country:US
Mailing Address - Phone:984-217-5437
Mailing Address - Fax:
Practice Address - Street 1:8841 SIX FORKS RD # 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2970
Practice Address - Country:US
Practice Address - Phone:984-217-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27279208000000X
NC5018797363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics