Mykenzie Moore

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MA068390 Issued in PA

Practice address

289 Hamburg Rd
Transfer, PA 16154-2601

Phone

(724) 841-4625

NPI assigned

Oct 14, 2026

Last updated

Oct 14, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1791936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791936000000",
    "number": "1245135656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "289 HAMBURG RD",
            "city": "TRANSFER",
            "state": "PA",
            "postal_code": "161542601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "289 HAMBURG RD",
            "city": "TRANSFER",
            "state": "PA",
            "postal_code": "161542601",
            "telephone_number": "724-841-4625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MYKENZIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-10-14",
        "last_updated": "2026-10-14",
        "certification_date": "2026-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA068390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachary Johnson, PHARMD
• Steven Jordan
• James J Kolenich, MD
• Tammy Harris Lantz, RN
• Daryl W List, D.O.
• Nystrom and Eckard
• Joel Erik Nystrom, M.D.
• Primary Health Network (Transfer Health Center)
• Primary Health Network
• Tracey Lynn Rusnak

• Medical Physician Assistant in Transfer, PA
• Providers in Transfer, PA by specialty
• Medical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2026; 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.