Active NPI
Makenzie Kaye Garrison, CNP
- Family Nurse Practitioner
- O Fallon, MO
National Provider Identifier
1437977568
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 2024039470
- Practice address
- 110 Triad Ctr W
O Fallon, MO 63366-7541 - Phone
- (314) 497-6046
- NPI assigned
- Sep 27, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2024039470 | MO | Primary |
Addresses
Primary practice location
110 Triad Ctr W
O Fallon, MO 63366-7541
Mailing address
110 Triad Ctr W
O Fallon, MO 63366-7541
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2024039470 | MO | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1727395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727395200000",
"number": "1437977568",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 TRIAD CTR W",
"city": "O FALLON",
"state": "MO",
"postal_code": "633667541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 TRIAD CTR W",
"city": "O FALLON",
"state": "MO",
"postal_code": "633667541",
"telephone_number": "314-497-6046"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARRISON",
"first_name": "MAKENZIE",
"middle_name": "KAYE",
"credential": "CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-09-27",
"last_updated": "2024-09-27",
"certification_date": "2024-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "2024039470",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in O Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.