Provider Demographics
NPI:1851105480
Name:GREENE, MCKENNA CASSELLA (PA)
Entity type:Individual
Prefix:MRS
First Name:MCKENNA
Middle Name:CASSELLA
Last Name:GREENE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 GOLDLEAF ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7457
Mailing Address - Country:US
Mailing Address - Phone:803-960-7859
Mailing Address - Fax:
Practice Address - Street 1:9 MEDICAL PARK DR SUITE 110
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant