Healthcare Provider Details

I. General information

NPI: 1194123364
Provider Name (Legal Business Name): ALLISON M. KRAKEEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2014
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 N HIGHWAY 52
MONCKS CORNER SC
29461-3924
US

IV. Provider business mailing address

PO BOX 749306
ATLANTA GA
30374-9306
US

V. Phone/Fax

Practice location:
  • Phone: 843-899-3870
  • Fax: 843-899-3877
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19136
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19136
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: