Healthcare Provider Details

I. General information

NPI: 1790534246
Provider Name (Legal Business Name): M'KAYLA ALSTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8121 ROURK ST
MYRTLE BEACH SC
29572-4128
US

IV. Provider business mailing address

8121 ROURK ST
MYRTLE BEACH SC
29572-4128
US

V. Phone/Fax

Practice location:
  • Phone: 843-692-5000
  • Fax: 843-692-5010
Mailing address:
  • Phone: 843-692-5000
  • Fax: 843-692-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: