Provider Demographics
NPI:1528944782
Name:WAUGH, MACKENZIE NICOLE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:NICOLE
Last Name:WAUGH
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 780
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0780
Mailing Address - Country:US
Mailing Address - Phone:304-285-7101
Mailing Address - Fax:
Practice Address - Street 1:14 COMFORT DR
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26547-1401
Practice Address - Country:US
Practice Address - Phone:304-864-0006
Practice Address - Fax:304-864-0015
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV123908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily