| NPI | 1972250504 |
|---|---|
| Former Name | MACKENZIE JO LONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KS 15-03207) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2023029157) |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2026-02-18 |