Provider Demographics
NPI:1972298974
Name:SHAMBLIN, MACKENZIE SIMPKINS (APRN, AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:SIMPKINS
Last Name:SHAMBLIN
Suffix:
Gender:F
Credentials:APRN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 ALBION LOOP
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29860-8040
Mailing Address - Country:US
Mailing Address - Phone:706-466-6404
Mailing Address - Fax:
Practice Address - Street 1:1123 ALBION LOOP
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-8040
Practice Address - Country:US
Practice Address - Phone:706-466-6404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN280788363L00000X
SC27530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner