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NPI Code Detail

MEDICARE: MOLLY KATE CAVANAUGH CRNA

MEDICARE: MOLLY KATE CAVANAUGH CRNA
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
1163WC0200XCritical Care Medicine Registered Nurse111137WV
2367500000XCertified Registered Nurse Anesthetist29035SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720717549
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY KATE CAVANAUGH CRNA
Provider Business Mailing Address
First Line : PO BOX 632509
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-2509
Country : US
Telephone Number : 803-765-1838
Fax Number : 803-765-1732
Provider Business Practice Location Address
First Line : 9263 MEDICAL PLAZA DR STE E
Second Line :
City : CHARLESTON
State : SC
Zip : 29406-7112
Country : US
Telephone Number : 843-572-1228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2022
Last Update Date : 04/08/2026

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Directions to “ MOLLY KATE CAVANAUGH CRNA” Practice Location

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