Individual
SHIRLEY BECTON MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PPCNP-BC
Contact information
Practice address
401 CARPENTER RD BLDG 525, 1015, FORT MYER, VA 22211-1009
(703) 696-3614
(703) 696-9248
Mailing address
401 CARPENTER RD BLDG 525, 1015, FORT MYER, VA 22211-1009
(833) 853-1392
(703) 696-9248
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
0017141236
VA
363LP0200X
Pediatric Nurse Practitioner
Primary
0024171110
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02807327
—
CO
05
—
02807327
—
VA
Enumeration date
10/25/2006
Last updated
08/08/2024
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