Healthcare Provider Details

I. General information

NPI: 1598484800
Provider Name (Legal Business Name): KELSEY ELIZABETH COUTSOS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2728 SUNSET BLVD STE 400
WEST COLUMBIA SC
29169-4872
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-936-7095
  • Fax:
Mailing address:
  • Phone: 803-791-2491
  • Fax: 803-794-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberPROCESSING
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26593
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: