Healthcare Provider Details

I. General information

NPI: 1558052944
Provider Name (Legal Business Name): MAKENZIE BACHMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9633 BITTER MELON DR
ANGIER NC
27501-5917
US

IV. Provider business mailing address

9633 BITTER MELON DR
ANGIER NC
27501-5917
US

V. Phone/Fax

Practice location:
  • Phone: 919-639-8900
  • Fax:
Mailing address:
  • Phone: 919-639-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-14118
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: