| NPI | 1518641166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY BURGESS Owner 843-319-6089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| 363LC1500X Nurse Practitioner, Community Health | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| 363LX0106X Nurse Practitioner, Occupational Health | |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2024-01-03 |