Healthcare Provider Details

I. General information

NPI: 1093623266
Provider Name (Legal Business Name): KATHERINE LUIBRAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 BROAD ST UNIT 606
CHARLESTON SC
29401-1870
US

IV. Provider business mailing address

310 BROAD ST UNIT 606
CHARLESTON SC
29401-1870
US

V. Phone/Fax

Practice location:
  • Phone: 315-760-7839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.32471
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: