Provider Demographics
NPI:1215671813
Name:LAVENGCO, MCKENZIE ELISE (PA-C)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:ELISE
Last Name:LAVENGCO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 E HWY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:713-213-6743
Mailing Address - Fax:
Practice Address - Street 1:1301 W 38TH ST STE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1010
Practice Address - Country:US
Practice Address - Phone:512-454-4561
Practice Address - Fax:512-406-7330
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15841363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant