Healthcare Provider Details

I. General information

NPI: 1043628746
Provider Name (Legal Business Name): KASEY CRISTINE O'SHIELDS MMSC, PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASEY RICHARDSON

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DOUGHTY ST STE 280
CHARLESTON SC
29403-5727
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-720-8317
  • Fax:
Mailing address:
  • Phone: 888-472-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5757
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA00635
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: