Healthcare Provider Details

I. General information

NPI: 1952243396
Provider Name (Legal Business Name): MACKENZIE CORLEY YANDLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 R L SAWYER MD DR
SALUDA SC
29138-9199
US

IV. Provider business mailing address

104 WELLS AVE
GREENWOOD SC
29646-3837
US

V. Phone/Fax

Practice location:
  • Phone: 864-725-5355
  • Fax:
Mailing address:
  • Phone: 864-725-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6460
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: