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Individual

MAKARIA KENZIE MCMULLEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
1390 US HIGHWAY 61 STE N1500, CRYSTAL CTY, MO 63028-4137
(636) 933-8050
(636) 933-8047
Mailing address
1390 US HIGHWAY 61 STE N1500, CRYSTAL CTY, MO 63028-4137
(636) 933-8050
(636) 933-8047

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2020027835
MO
363L00000X
Nurse Practitioner
2020027835
MO
363LF0000X
Family Nurse Practitioner
Primary
2026005553
MO

Other

Enumeration date
11/03/2025
Last updated
03/26/2026
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