MEDICARE: STEPHENIE MEIXING YI REXROAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	1494	SC

General Provider Information

NPI Number	:	1225781750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHENIE MEIXING YI REXROAD

Provider Business Mailing Address
First Line	:	2093 HENRY TECKLENBURG DR STE 200E
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5742
Country	:	US
Telephone Number	:	843-402-3114
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 CROSSCREEK DR APT B2
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2509
Country	:	US
Telephone Number	:	304-203-9607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	04/24/2025

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