Kristin Diane McKenzie, DNP, BSN, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

401631 Issued in NY

Practice address

3055 Southwestern Blvd Ste 110
Orchard Park, NY 14127-1231

Phone

(716) 903-6036

Fax

(716) 463-2225

NPI assigned

Jul 11, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor on Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Illuminate NP Psychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Orchard Park, NY
  • NPI 1003671009
  NPD
• Illuminate NP Psychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Orchard Park, NY
  • NPI 1871184424
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1053752626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3055 SOUTHWESTERN BLVD STE 110",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141271231",
            "telephone_number": "716-903-6036",
            "fax_number": "716-463-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 SOUTHWESTERN BLVD STE 110",
            "city": "ORCHARD PARK",
            "state": "NY",
            "postal_code": "141271231",
            "telephone_number": "716-903-6036",
            "fax_number": "716-463-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "KRISTIN",
        "middle_name": "DIANE",
        "credential": "DNP, BSN, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-11",
        "last_updated": "2024-04-02",
        "certification_date": "2024-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "562312",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "401631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura McGowan, D.O.
• Patricia Elaine McGrane
• Malcolm C McIsaac, MD
• Gail McKee
• Alyssa McKeever, LMHC
• Renee McKenzie, DPT
• Richard Thomas McLanahan, D.M.D.
• Mary Clare McLaughlin, PA-C
• Kathleen A. McLeron, PA-C
• Lynn S McMaster, SLP

• Psychiatric/Mental Health Nurse Practitioner in Orchard Park, NY
• Providers in Orchard Park, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.