Healthcare Provider Details

I. General information

NPI: 1033161823
Provider Name (Legal Business Name): KAY HORRES DURST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 STATION 22 1/2 ST
SULLIVANS IS SC
29482-9756
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-883-3176
  • Fax: 843-883-3459
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME79121
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: