Provider Demographics
NPI:1508322504
Name:MACKUSICK, CAROL ISAAC (AGNP-C)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ISAAC
Last Name:MACKUSICK
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2197 UPPER WHITEWATER RD
Mailing Address - Street 2:
Mailing Address - City:SAPPHIRE
Mailing Address - State:NC
Mailing Address - Zip Code:28774-9753
Mailing Address - Country:US
Mailing Address - Phone:828-506-4989
Mailing Address - Fax:
Practice Address - Street 1:89 HOSPITAL DR STE B
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-4838
Practice Address - Country:US
Practice Address - Phone:828-506-4989
Practice Address - Fax:828-883-3331
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011510363L00000X
NCMACK-18NGWV363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner