Healthcare Provider Details

I. General information

NPI: 1275653461
Provider Name (Legal Business Name): ERIN KELLEY RUSE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN L KELLEY PA-C

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 HENRY TECKLENBURG DR STE 300E
CHARLESTON SC
29414-5743
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2011
  • Fax: 843-606-7991
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1202
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: