Provider Demographics
NPI:1558052944
Name:BACHMAN, MAKENZIE (PA-C)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:BACHMAN
Suffix:
Gender:
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 1:9633 BITTER MELON DR
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-5917
Mailing Address - Country:US
Mailing Address - Phone:919-639-8900
Mailing Address - Fax:
Practice Address - Street 1:9633 BITTER MELON DR
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-5917
Practice Address - Country:US
Practice Address - Phone:919-639-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-14118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant