Individual provider Active NPI

McKenzie Lynn Tibbs, DO

  • Dermatology Physician
  • Goldsboro, NC
National Provider Identifier
1871242529
Registry record updated Jul 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
334294 Issued in NC
Practice address
2613 Hospital Rd
Goldsboro, NC 27534-9424
Phone
(919) 736-0222
Fax
(919) 736-0223
NPI assigned
Mar 21, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 334294 NC Primary

Addresses

Primary practice location

2613 Hospital Rd
Goldsboro, NC 27534-9424

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220630002175 VA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 4385024843

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Liberty Univ College of Osteopathic Medicine, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

801 York St
Manitowoc, WI 54220-4630

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
334294NCMDDermatology Physician

NPI Registry JSON

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

{
    "created_epoch": "1647820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782864000000",
    "number": "1871242529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2613 HOSPITAL RD",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275349424",
            "telephone_number": "919-736-0222",
            "fax_number": "919-736-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBBS",
        "first_name": "MCKENZIE",
        "middle_name": "LYNN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-21",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "334294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goldsboro, NC

Sources for this page

Verify at the official NPI Registry.