Healthcare Provider Details

I. General information

NPI: 1750939021
Provider Name (Legal Business Name): KAYLA NICOLE SMITH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 HINSON DR STE 3
MYRTLE BEACH SC
29579-4435
US

IV. Provider business mailing address

310 HINSON DR STE 3
MYRTLE BEACH SC
29579-4435
US

V. Phone/Fax

Practice location:
  • Phone: 843-966-0613
  • Fax: 843-628-0979
Mailing address:
  • Phone: 843-966-0613
  • Fax: 843-628-0979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3328
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: