Healthcare Provider Details

I. General information

NPI: 1871242529
Provider Name (Legal Business Name): MCKENZIE LYNN TIBBS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 HOSPITAL RD
GOLDSBORO NC
27534-9424
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 919-736-0222
  • Fax: 919-736-0223
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number334294
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: