Provider Demographics
NPI:1235970948
Name:JESIKAMCKENZIEBHI LLC
Entity type:Organization
Organization Name:JESIKAMCKENZIEBHI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-997-7041
Mailing Address - Street 1:10142 W GROSS AVE
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-1204
Mailing Address - Country:US
Mailing Address - Phone:602-977-7041
Mailing Address - Fax:602-997-7126
Practice Address - Street 1:10142 W GROSS AVE
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-1204
Practice Address - Country:US
Practice Address - Phone:602-977-7041
Practice Address - Fax:602-997-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty