Individual provider Active NPI

Lisa McKenzie

  • Family Nurse Practitioner
  • Dothan, AL
National Provider Identifier
1174389415
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11030485 Issued in FL
Practice address
4370 W Main St
Dothan, AL 36305-1056
Phone
(334) 793-5000
NPI assigned
Feb 26, 2024
Last updated
Jan 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11030485 FL Primary

Addresses

Primary practice location

4370 W Main St
Dothan, AL 36305-1056

Mailing address

4370 W Main St
Dothan, AL 36305-1056
Phone (334) 793-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240429003042 AL Practitioner - Nurse Practitioner 0749627636 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Flowers HB Medical Services LLCGroup PAC ID 6305290990, 139 clinicians

Practice addresses (Care Compare)

4370 W Main St
Dothan, AL 36305-1056
Phone (334) 793-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
11030485FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Flowers HB Medical Services LLC CurrentSince Apr 16, 2024 Accepting new patients

Locations

4370 W Main St
Dothan, AL 36305
Phone (256) 332-1611

Organizations & group practices 1

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1708905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1174389415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4370 W MAIN ST",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051056",
            "telephone_number": "334-793-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4370 W MAIN ST",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051056",
            "telephone_number": "334-793-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "LISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-26",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11030485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.