Healthcare Provider Details

I. General information

NPI: 1750981833
Provider Name (Legal Business Name): KAITLYN MARIE MCGUIGAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN SKELSTON

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 03/18/2024
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GRAND STRAND PEDIATRICS 1120 GLENNS BAY ROAD
SURFSIDE BEACH SC
29575
US

IV. Provider business mailing address

GRAND STRAND PEDIATRICS 8120 ROURK STREET
MYRTLE BEACH SC
29572
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-1438
  • Fax: 843-286-1349
Mailing address:
  • Phone: 843-449-1438
  • Fax: 843-286-1349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3619
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: