Healthcare Provider Details

I. General information

NPI: 1831013168
Provider Name (Legal Business Name): MACKENZIE MARIE RINE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 RAEFORD RD STE 100
FAYETTEVILLE NC
28303-5437
US

IV. Provider business mailing address

22 GRANITE KNOB WAY APT 104
ASHEVILLE NC
28806-0238
US

V. Phone/Fax

Practice location:
  • Phone: 910-996-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16951
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: