Individual provider Active NPI

McKenzie Hart

  • Physician Assistant
  • Idaho Falls, ID
National Provider Identifier
1578059143
Registry record updated Jun 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1637 Issued in ID
Practice address
3200 Channing Way Ste A206
Idaho Falls, ID 83404-7586
Phone
(208) 529-2230
Fax
(208) 561-8061
NPI assigned
Jul 7, 2018
Last updated
Jun 9, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-1637 ID Primary

Addresses

Primary practice location

3200 Channing Way Ste A206
Idaho Falls, ID 83404-7586

Mailing address

3200 Channing Way Ste A206
Idaho Falls, ID 83404-7586
Phone (208) 529-2230

Other names 1

  • Miss McKenzie Lee Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20181128002830 ID Practitioner - Physician Assistant 4981948189 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Steele Lake Specialty PLLCGroup PAC ID 1153774567, 20 clinicians

Practice addresses (Care Compare)

3200 Channing Way
Suite A206
Idaho Falls, ID 83404-7586
Phone (208) 529-2230

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho Physician Services Inc. PastSince Apr 22, 2023 Accepting new patients

Organizations & group practices 3

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": "1530921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780963200000",
    "number": "1578059143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 CHANNING WAY STE A206",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047586",
            "telephone_number": "208-529-2230",
            "fax_number": "208-561-8061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 CHANNING WAY STE A206",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047586",
            "telephone_number": "208-529-2230",
            "fax_number": "208-561-8061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HART",
        "first_name": "MCKENZIE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-07",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MCKENZIE",
            "last_name": "LEE",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.