Healthcare Provider Details

I. General information

NPI: 1316710486
Provider Name (Legal Business Name): ALEXIS KIEFER MS, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 S LIVE OAK DR
MONCKS CORNER SC
29461-8737
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-958-2590
  • Fax: 843-606-7996
Mailing address:
  • Phone: 437-891-6208
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2783
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: