MEDICARE: KERRIA PERNELL

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	101Y00000X	Counselor	8890	SC

General Provider Information

NPI Number	:	1396597415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRIA PERNELL

Provider Business Mailing Address
First Line	:	106 W CALHOUN ST
Second Line	:
City	:	DILLON
State	:	SC
Zip	:	29536-4014
Country	:	US
Telephone Number	:	843-632-1320
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 W CALHOUN ST
Second Line	:
City	:	DILLON
State	:	SC
Zip	:	29536-4014
Country	:	US
Telephone Number	:	843-632-1320
Fax Number	:

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

Provider Enumeration Date	:	04/02/2024
Last Update Date	:	04/02/2024

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Directions to “ KERRIA PERNELL ” Practice Location

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