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

Mrs. Olivia Mackenzie King, PA

Individual provider Physician Assistant · NPI 1366276149

Mrs. Olivia Mackenzie King, PA is a Physician Assistant in South Bend, Indiana. Qualified in 2024, 2 years ago. Practices with Cardinal Dermatology LLC, a 6-clinician group and accepts Medicare assignment.

Years since qualifying
2
In the registry since
2024
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

4322 Lafayette Blvd
South Bend, IN 46614
Phone: (574) 391-1111
Fax: (574) 859-5040
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1366276149
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedAugust 26, 2024
Last updated in NPPESAugust 26, 2024
Certification dateAugust 1, 2024

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 Cardinal Dermatology Llc — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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