Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Mackenzie Brannon Bonilla Reyes, PA-C

Individual provider Physician Assistant · NPI 1073360277

Mrs. Mackenzie Brannon Bonilla Reyes, PA-C is a Physician Assistant in Charlotte, North Carolina. Qualified in 2024, 2 years ago. Practices with Wake Forest Emergency Providers, a 489-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
2
Licensed in
NC
In the registry since
2024
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

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone: (704) 446-5185
Fax: (704) 446-0221
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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 0010-15028 (NC)

Record details

NPI number1073360277
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedMay 4, 2024
Last updated in NPPESJanuary 28, 2025
Certification dateJanuary 28, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Wake Forest Emergency Providers — 489 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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