Healthcare Provider Details

I. General information

NPI: 1164052502
Provider Name (Legal Business Name): KYLIE D GRATTON APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 SEA ISLAND PKWY
LADYS ISLAND SC
29907-1503
US

IV. Provider business mailing address

200 OLD PLANTATION DR W
LADYS ISLAND SC
29907-1005
US

V. Phone/Fax

Practice location:
  • Phone: 843-322-1933
  • Fax:
Mailing address:
  • Phone: 843-816-1463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23517
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: