Healthcare Provider Details

I. General information

NPI: 1790027464
Provider Name (Legal Business Name): ANNETTE KAO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 COMMONWEALTH DR STE 120
GREENVILLE SC
29615-4881
US

IV. Provider business mailing address

4 LANDSTONE CT
GREER SC
29650-3687
US

V. Phone/Fax

Practice location:
  • Phone: 864-675-4600
  • Fax:
Mailing address:
  • Phone: 864-363-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22230
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number213514
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: