Healthcare Provider Details

I. General information

NPI: 1255039707
Provider Name (Legal Business Name): KID CARE PEDIATRIC URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 MAIN ST STE A
CONWAY SC
29526-5129
US

IV. Provider business mailing address

212 MAIN ST STE A
CONWAY SC
29526-5129
US

V. Phone/Fax

Practice location:
  • Phone: 843-340-2672
  • Fax:
Mailing address:
  • Phone: 843-488-7337
  • Fax: 843-488-7338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. SUMMER WATTS
Title or Position: FNP
Credential: APRN, FNP
Phone: 843-340-2672