Individual
MCKENZIE LIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17 MEDICAL PLZ, MOUNTAIN HOME, AR 72653-2918
(870) 508-5900
Mailing address
190 SAWYER HOLW, PINEVILLE, AR 72566-8878
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
122844
AR
Other
Enumeration date
09/27/2023
Last updated
09/27/2023
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