Healthcare Provider Details

I. General information

NPI: 1851942312
Provider Name (Legal Business Name): SABRINA KELLY PACKETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E CHEVES ST
FLORENCE SC
29506-2526
US

IV. Provider business mailing address

306 LYNDALE DR
HARTSVILLE SC
29550-2706
US

V. Phone/Fax

Practice location:
  • Phone: 843-673-6544
  • Fax:
Mailing address:
  • Phone: 843-319-9929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number47981
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: