Provider Demographics
NPI:1326614363
Name:MCKENZIE, RAINA ELAINE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:RAINA
Middle Name:ELAINE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-355-5459
Mailing Address - Fax:843-355-9704
Practice Address - Street 1:512 NELSON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4027
Practice Address - Country:US
Practice Address - Phone:843-355-5459
Practice Address - Fax:843-355-9704
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
SC4018363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical