Healthcare Provider Details

I. General information

NPI: 1740354091
Provider Name (Legal Business Name): KATHLEEN MEGAN ROBERTS NREMT, INDEPENDENT D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 REGISTER STREET COMMANDING OFFICER CGC OAR
NORTH CHARLESTON SC
29405
US

IV. Provider business mailing address

1050 REGISTER STREET COMMANDING OFFICER CGC OAR
NORTH CHARLESTON SC
29405
US

V. Phone/Fax

Practice location:
  • Phone: 843-554-8541
  • Fax: 843-554-2543
Mailing address:
  • Phone: 843-554-8541
  • Fax: 843-554-2543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: