Provider Demographics
NPI:1467277566
Name:THOMPKINS, MACKENZIE JONES
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:JONES
Last Name:THOMPKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 GUNTERS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:GALIVANTS FERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29544-8965
Mailing Address - Country:US
Mailing Address - Phone:843-997-3232
Mailing Address - Fax:
Practice Address - Street 1:3617 CASEY ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2981
Practice Address - Country:US
Practice Address - Phone:843-756-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29494363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner