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MACKENZIE NOELLE TEWKSBURY PA-C
NPI 1780484899
Physician Assistant in Roanoke, VA

Active since March 17, 2025PECOS Enrolled
3 RIVERSIDE CIR, ROANOKE, VA 24016(540) 224-5170(540) 985-9427 Get Directions Write a Review

NPPES record last updated: March 13, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 13, 2026, Jan 12, 2026, Dec 22, 2025 and 1 more (4 updates tracked since 2025).

About Mackenzie Noelle Tewksbury Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MACKENZIE NOELLE TEWKSBURY PA-C (NPI 1780484899) is an individual physician assistant in Roanoke, Virginia, licensed in Virginia (0110011587) and active in the NPI registry since March 2025. She is enrolled in Medicare PECOS, maintains a secondary practice location in Roanoke, and is a graduate of Other (2025).

NPPES Registry Identity

NPI1780484899
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMACKENZIE NOELLE TEWKSBURYCredential: PA-C
Location Address3 RIVERSIDE CIRRoanoke, VA 24016-4955
Mailing Address213 S Jefferson St Ste 1006Roanoke, VA 24011-1713 · (540) 224-5372
Phone(540) 224-5170
Fax(540) 985-9427
Sole ProprietorNo
Medical School CMSOtherGraduated 2025
Enumeration DateMarch 17, 2025
Last NPPES UpdateMarch 13, 20264 updates tracked since enumeration
NPPES CertifiedMarch 13, 2026
✔ NPI 1780484899 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in VA · 0110011587
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
3 RIVERSIDE CIR, Roanoke, VA 24016
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Secondary Practice Location 1

Location 11906 Belleview Ave SERoanoke, VA 24014-1838 · Phone (540) 981-7000

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mackenzie Noelle Tewksbury Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9436634094
PECOS Enrollment IDI20260401000094
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 24016 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$86.88 typical visit price
range $56.19 – $170.30
Typical copayment $21.72 (range $14.04 – $42.57)
Most-billed visit code 99203
Established Patient
$70.08 typical visit price
range $18.07 – $138.91
Typical copayment $17.52 (range $4.51 – $34.72)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. JED DAVID GONZALO M.D.
Internal Medicine
3 RIVERSIDE CIR
ROANOKE, VA 24016
Roanoke City (540) 224-5170
KRISTIN MCCOY MD
Surgery
3 RIVERSIDE CIR
ROANOKE, VA 24016
Roanoke City (540) 224-5170
MRS. MODUPE OLUWASEYI JOLAOSO WHITE FNP-C
Nurse Practitioner (Family)
3 RIVERSIDE CIR
ROANOKE, VA 24016
Roanoke City (540) 224-5170
KELLY KUGACH
Podiatrist (Foot & Ankle Surgery)
3 RIVERSIDE CIR
ROANOKE, VA 24016
Roanoke City (540) 510-6200
VISHAL B. GOHIL M.D.
Internal Medicine (Gastroenterology)
3 RIVERSIDE CIR
ROANOKE, VA 24016
Roanoke City (540) 224-5170
CARLOS MORA
Psychiatry & Neurology (Neurology)
3 RIVERSIDE CIR
ROANOKE, VA 24016
Roanoke City (540) 224-5170
DR. GUY KATZ MD
Surgery
3 RIVERSIDE CIR
ROANOKE, VA 24016
Roanoke City (540) 224-5170
ASTRID BOTTY VAN DEN BRUELE M.D.
Surgery
3 RIVERSIDE CIR
ROANOKE, VA 24016
Roanoke City (540) 224-5170

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mackenzie Tewksbury's NPI number?

The NPI number for Mackenzie Tewksbury is 1780484899. It was assigned to this individual provider in the NPPES registry on March 17, 2025.

Where is Mackenzie Tewksbury located?

Mackenzie Tewksbury practices at 3 Riverside Cir, Roanoke, VA 24016. The listed phone number is (540) 224-5170.

What is Mackenzie Tewksbury's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Mackenzie Tewksbury enrolled in Medicare?

Yes. Mackenzie Tewksbury is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Mackenzie Tewksbury was last updated on March 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.