Healthcare Provider Details

I. General information

NPI: 1225420466
Provider Name (Legal Business Name): KATHERINE C PROFFER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 GREYTHORNE DR
MOUNT PLEASANT SC
29466-6332
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 864-686-6163
  • Fax: 864-686-6166
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19313
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: