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Individual

MS. MCKENZIE ANNE MATLOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
3801 S NATIONAL AVE, DIV PED HOSPITALIST MED, SPRINGFIELD, MO 65807-5210
(417) 269-7728
(417) 269-7729
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(417) 269-7728
(417) 269-7729

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2018003866
MO
363AM0700X
Medical Physician Assistant
Primary
2018003866
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
220051879
MO
Enumeration date
02/15/2018
Last updated
04/14/2026
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