Provider Demographics
NPI:1861538654
Name:MCKENZIE, PATRICIA FLYNN (BC, ANP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:FLYNN
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:BC, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16134 BARRIER REEF CT
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1815
Mailing Address - Country:US
Mailing Address - Phone:636-527-0758
Mailing Address - Fax:
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:PRIMARY CARE SERVICE LINE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO143563363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428744205Medicaid
MO428744205Medicaid
MO000081373Medicare ID - Type Unspecified