Healthcare Provider Details

I. General information

NPI: 1053817411
Provider Name (Legal Business Name): ERICA KOUNS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N FRASER ST
GEORGETOWN SC
29440-2848
US

IV. Provider business mailing address

PO BOX 421718
GEORGETOWN SC
29442-4203
US

V. Phone/Fax

Practice location:
  • Phone: 843-692-1000
  • Fax:
Mailing address:
  • Phone: 843-652-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberPENDING
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: