Healthcare Provider Details

I. General information

NPI: 1306502406
Provider Name (Legal Business Name): RACHEL ERIN BROTT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 JONATHAN LUCAS ST
CHARLESTON SC
29425-8900
US

IV. Provider business mailing address

1942 WEEPING CYPRESS DR
CHARLESTON SC
29412-2592
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3167
  • Fax:
Mailing address:
  • Phone: 703-987-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA063250
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMPA.6395
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: