Healthcare Provider Details

I. General information

NPI: 1326620246
Provider Name (Legal Business Name): MCKENZIE D WARDWELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 CHUCK DAWLEY BLVD STE D100
MOUNT PLEASANT SC
29464-4149
US

IV. Provider business mailing address

1037 CHUCK DAWLEY BLVD STE D100
MOUNT PLEASANT SC
29464-4149
US

V. Phone/Fax

Practice location:
  • Phone: 843-962-2999
  • Fax: 843-790-1949
Mailing address:
  • Phone: 843-962-2999
  • Fax: 843-790-1949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347600
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25838
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: