Provider Demographics
NPI:1134095193
Name:MCKENZIE, BERNICE M
Entity type:Individual
Prefix:
First Name:BERNICE
Middle Name:M
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-9265
Mailing Address - Country:US
Mailing Address - Phone:843-437-6598
Mailing Address - Fax:
Practice Address - Street 1:1220 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-9265
Practice Address - Country:US
Practice Address - Phone:843-437-6598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC003451562172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver