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NPI Code Detail

MEDICARE: KAYLA PETERSON TAVERNIER

MEDICARE: KAYLA PETERSON TAVERNIER
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
1363A00000XPhysician AssistantPA2419SC

General Provider Information

NPI Number : 1346610524
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLA PETERSON TAVERNIER
Provider Business Mailing Address
First Line : 901 W GREENWOOD ST
Second Line : SUITE 9
City : ABBEVILLE
State : SC
Zip : 29620-5717
Country : US
Telephone Number : 864-366-9681
Fax Number :
Provider Business Practice Location Address
First Line : 901 W GREENWOOD ST STE 1
Second Line :
City : ABBEVILLE
State : SC
Zip : 29620-5727
Country : US
Telephone Number : 864-366-9681
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2015
Last Update Date : 01/06/2023

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Directions to “ KAYLA PETERSON TAVERNIER ” Practice Location

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