Healthcare Provider Details

I. General information

NPI: 1649774407
Provider Name (Legal Business Name): DEANNA LEE KITCHEN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANNA LEE MORELLI

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 FARRAR DR
CONWAY SC
29526-8747
US

IV. Provider business mailing address

1303 AZALEA CT STE B
MYRTLE BEACH SC
29577-5765
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-8111
  • Fax:
Mailing address:
  • Phone: 843-692-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number92039
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberS3218
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: