Healthcare Provider Details

I. General information

NPI: 1043509144
Provider Name (Legal Business Name): KATHRYN ANNE BORKERT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 RIVERS AVE
NORTH CHARLESTON SC
29406-6053
US

IV. Provider business mailing address

5880 RIVERS AVE
NORTH CHARLESTON SC
29406-6053
US

V. Phone/Fax

Practice location:
  • Phone: 843-725-4673
  • Fax: 843-725-1235
Mailing address:
  • Phone: 843-725-4673
  • Fax: 843-725-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1622
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: