Healthcare Provider Details

I. General information

NPI: 1073427472
Provider Name (Legal Business Name): KAITLYN MCNINCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HUDSON ST
CHESTER SC
29706-1524
US

IV. Provider business mailing address

602 OLD YORK RD
CHESTER SC
29706-5214
US

V. Phone/Fax

Practice location:
  • Phone: 803-377-8111
  • Fax:
Mailing address:
  • Phone: 803-374-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: