Healthcare Provider Details

I. General information

NPI: 1104747377
Provider Name (Legal Business Name): MCKENZIE TORREN LAWRENCE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E GROVER ST
SHELBY NC
28150-3917
US

IV. Provider business mailing address

2802 BLUE CREEK RD
LENOIR NC
28645-7618
US

V. Phone/Fax

Practice location:
  • Phone: 833-783-1779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-16832
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: