Healthcare Provider Details

I. General information

NPI: 1598685182
Provider Name (Legal Business Name): WAACHOVIA ONDRA KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 COLONY DR
RIDGELAND SC
29936-6599
US

IV. Provider business mailing address

210 COLONY DR
RIDGELAND SC
29936-6599
US

V. Phone/Fax

Practice location:
  • Phone: 843-941-3716
  • Fax:
Mailing address:
  • Phone: 843-941-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number613482
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: