Healthcare Provider Details

I. General information

NPI: 1609219393
Provider Name (Legal Business Name): KAREN SCRUGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 N HIGHWAY 41A
MARION SC
29571-6481
US

IV. Provider business mailing address

402 KIMBALL DR
MARION SC
29571-1916
US

V. Phone/Fax

Practice location:
  • Phone: 843-423-8345
  • Fax: 843-423-8378
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number26296
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: