Healthcare Provider Details

I. General information

NPI: 1811739329
Provider Name (Legal Business Name): KAITLIN FRAZIER STEVENS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN CAROL FRAZIER

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CARRIAGE LN
CHARLESTON SC
29407-6010
US

IV. Provider business mailing address

1838 WHISPERWOOD RD
JOHNS ISLAND SC
29455-8297
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-3100
  • Fax:
Mailing address:
  • Phone: 843-469-3514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28549
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: