Healthcare Provider Details

I. General information

NPI: 1144473646
Provider Name (Legal Business Name): KAYCE DOUGLAS HUFFSTETLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COLONIAL DR COTTAGE C
COLUMBIA SC
29203-6827
US

IV. Provider business mailing address

726 POSTON DR
ROCK HILL SC
29732-7838
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-2270
  • Fax:
Mailing address:
  • Phone: 803-366-9570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number058 559 979
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: