Healthcare Provider Details

I. General information

NPI: 1407647043
Provider Name (Legal Business Name): ANDREW KEDDY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD
GREENVILLE SC
29605-4210
US

IV. Provider business mailing address

215 PROMENADE VISTA ST APT 3125
CHARLESTON SC
29412-5125
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7000
  • Fax:
Mailing address:
  • Phone: 864-546-8664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number259677
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: