Healthcare Provider Details

I. General information

NPI: 1891616884
Provider Name (Legal Business Name): KEVAN FEGELY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 RIVERS AVE STE 105
NORTH CHARLESTON SC
29406-4829
US

IV. Provider business mailing address

6650 RIVERS AVE STE 105
NORTH CHARLESTON SC
29406-4829
US

V. Phone/Fax

Practice location:
  • Phone: 843-997-5690
  • Fax:
Mailing address:
  • Phone: 843-997-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number32813
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: