Basic Information
| Provider Information | |||||||||
| NPI: | 1144629197 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRINCE | ||||||||
| FirstName: | MACKENZIE | ||||||||
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| Credential: | APRN FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1917 N LAKE DR | ||||||||
| Address2: | |||||||||
| City: | WEATHERFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760856968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102183193 | ||||||||
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| Practice Location | |||||||||
| Address1: | 717 MAGNOLIA ST | ||||||||
| Address2: | |||||||||
| City: | JACKSBORO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764581111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405676633 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2014 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 532811 | TX | N | Nursing Service Providers | Registered Nurse | 163WE0003X | 532811 | TX | N | Nursing Service Providers | Registered Nurse | Emergency | 363LF0000X | AP126759 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.