Individual
MCKENZIE K MANGUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
401 N MAIN ST, ROANOKE, IL 61561-7585
(309) 923-2661
(309) 923-7628
Mailing address
401 N MAIN ST, ROANOKE, IL 61561-7585
(309) 923-2661
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085011710
IL
Other
Enumeration date
08/14/2023
Last updated
01/15/2026
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