Individual
CHRISTEN MARIE MACKORELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
180 WINGO WAY STE 301, MOUNT PLEASANT, SC 29464-1812
(843) 884-0302
(843) 849-9308
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2790
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3043PA
—
SC
Enumeration date
07/26/2017
Last updated
03/08/2021
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