Healthcare Provider Details

I. General information

NPI: 1760393524
Provider Name (Legal Business Name): KELLIE QUIGGLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 ELMS CENTER RD
NORTH CHARLESTON SC
29406-9844
US

IV. Provider business mailing address

2000 SAM RITTENBERG BLVD STE 2011
CHARLESTON SC
29407-4631
US

V. Phone/Fax

Practice location:
  • Phone: 843-302-8840
  • Fax: 843-818-2188
Mailing address:
  • Phone: 843-793-2104
  • Fax: 843-654-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32742
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: