Provider Demographics
NPI:1720812803
Name:RICHARDSON, MACKENZIE CIHAK (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:CIHAK
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61298 HUCKLEBERRY PL
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3357
Mailing Address - Country:US
Mailing Address - Phone:231-670-1191
Mailing Address - Fax:
Practice Address - Street 1:61298 HUCKLEBERRY PL
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3357
Practice Address - Country:US
Practice Address - Phone:231-670-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201503624RN163WP0808X
OR10046209363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health