Individual
JACOB MCKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1340 HAL GREER BLVD, HUNTINGTON, WV 25701
(304) 638-9517
Mailing address
2725 ROUTE 75, KENOVA, WV 25530-9793
(304) 638-9517
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN79908CRNA
WV
Other
Enumeration date
03/08/2018
Last updated
07/04/2018
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