Makenzie T Tiller, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2189 Issued in WV

Practice address

707 Chestnut St
South Charleston, WV 25309-2003

Phone

(304) 768-8500

Fax

(304) 768-8530

NPI assigned

Jul 5, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Boone Memorial Hospital, Inc

  • Multi-Specialty Clinic/Center
  • Madison, WV
  • NPI 1285686725
  Medicare reassignment NPD
• Lincoln County Primary Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hamlin, WV
  • NPI 1942274543
  Medicare reassignment NPD
• Boone Memorial Hospital, Inc

  • Rural Health Clinic/Center
  • Comfort, WV
  • NPI 1407421431
  NPD
• Boone Memorial Hospital, Inc

  • Psychiatry Physician
  • Madison, WV
  • NPI 1871141366

  Physician Assistant

  NPD
• Lincoln County Primary Care Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Hamlin, WV
  • NPI 1962583054
  NPD
• Spring Hill Primary Care Physicians PLLC

  • Internal Medicine Physician
  • South Charleston, WV
  • NPI 1306811781
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1871089508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 CHESTNUT ST",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253092003",
            "telephone_number": "304-768-8500",
            "fax_number": "304-768-8530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 CHESTNUT ST",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253092003",
            "telephone_number": "304-768-8500",
            "fax_number": "304-768-8530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLER",
        "first_name": "MAKENZIE",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-05",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "2189",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WV",
            "license": "2189",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Thornton
• THS Physician Partners Inc
• Crystal Thurman
• Donna Thurston
• Nachette Tibbs, RPH
• Victoria Timbers
• Gracie Tincher
• Susan Tincher
• Keaira Tipton
• To Healthy Eyes

• Physician Assistant in South Charleston, WV
• Providers in South Charleston, WV by specialty
• Physician Assistant in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.