Healthcare Provider Details

I. General information

NPI: 1669905741
Provider Name (Legal Business Name): CHELSEY KIGHT ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 MEDICAL PLAZA DR
NORTH CHARLESTON SC
29406-9104
US

IV. Provider business mailing address

9330 MEDICAL PLAZA DR
NORTH CHARLESTON SC
29406-9104
US

V. Phone/Fax

Practice location:
  • Phone: 843-847-4838
  • Fax: 843-847-4991
Mailing address:
  • Phone: 843-847-4838
  • Fax: 843-847-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number20762
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number20762
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: