MEDICARE: MACKENZIE JONES THOMPKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	29494	SC

General Provider Information

NPI Number	:	1467277566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE JONES THOMPKINS

Provider Business Mailing Address
First Line	:	4150 GUNTERS ISLAND RD
Second Line	:
City	:	GALIVANTS FERRY
State	:	SC
Zip	:	29544-8965
Country	:	US
Telephone Number	:	843-997-3232
Fax Number	:

Provider Business Practice Location Address
First Line	:	3617 CASEY ST
Second Line	:
City	:	LORIS
State	:	SC
Zip	:	29569-2981
Country	:	US
Telephone Number	:	843-756-3150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2024
Last Update Date	:	11/22/2024

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