Healthcare Provider Details

I. General information

NPI: 1730037433
Provider Name (Legal Business Name): KAYLEY BRIANNA CROOMS MCGOWAN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ALLEN CT
NORTH AUGUSTA SC
29860-9782
US

IV. Provider business mailing address

140 ALLEN CT
NORTH AUGUSTA SC
29860-9782
US

V. Phone/Fax

Practice location:
  • Phone: 803-510-0007
  • Fax: 803-510-0144
Mailing address:
  • Phone: 803-510-0007
  • Fax: 803-510-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number31695
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: