Healthcare Provider Details

I. General information

NPI: 1043143712
Provider Name (Legal Business Name): SIERA MAKENZIE KIRBY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 HIGHWAY 17 STE 200
MURRELLS INLET SC
29576-5032
US

IV. Provider business mailing address

654 BELLAMY AVE BOX 691
MURRELLS INLET SC
29576-5032
US

V. Phone/Fax

Practice location:
  • Phone: 843-651-4600
  • Fax:
Mailing address:
  • Phone: 843-651-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: