Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mackenzie R Tiderington, PA-C

Individual provider Physician Assistant · NPI 1114577103

Mackenzie R Tiderington, PA-C is a Physician Assistant in Dayton, Ohio. Qualified in 2019, 7 years ago. Practices with Orthopedic Associates of SW Ohio Inc, a 59-clinician group and accepts Medicare assignment. Licensed in Ohio.

Years since qualifying
7
Licensed in
OH
In the registry since
2019
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

4160 Little York Rd Ste 10
Dayton, OH 45414-5803
Phone: (937) 415-9100
Fax: (937) 415-9191
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 50.006159RX (OH)

Record details

NPI number1114577103
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 12, 2019
Last updated in NPPESDecember 4, 2022
Certification dateDecember 4, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Orthopedic Associates Of Sw Ohio Inc — 59 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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