MEDICARE: MCKAYLA P HENNESSEE

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	104100000X	Social Worker	13911	SC

General Provider Information

NPI Number	:	1528882438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKAYLA P HENNESSEE

Provider Business Mailing Address
First Line	:	311 MEETZE AVE
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 MEETZE AVE
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2625
Country	:	US
Telephone Number	:	803-553-3837
Fax Number	:

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

Provider Enumeration Date	:	11/08/2024
Last Update Date	:	11/08/2024

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Directions to “ MCKAYLA P HENNESSEE ” Practice Location

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