Healthcare Provider Details

I. General information

NPI: 1497997209
Provider Name (Legal Business Name): KOREY RICHARD GRAETTINGER APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HEALTHY WAY STE 1120
ANDERSON SC
29621-7915
US

IV. Provider business mailing address

PO BOX 100174
COLUMBIA SC
29202-3174
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-4530
  • Fax: 864-512-4540
Mailing address:
  • Phone: 864-512-4530
  • Fax: 864-512-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24327
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: