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General NPI Number Information
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NPI Number | 1023426921
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Entity Type | Individual
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Provider Name | CARITA KIELY PENNO PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 11/03/2024
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Provider Practice Location Address
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Address Line | 1014 SAINT ANDREWS BLVD
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City | CHARLESTON
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State | SC
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Zip | 29407-7177
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Country | US
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Telephone | 843-556-5585
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Fax | 843-556-5587
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Provider Business Mailing Address
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Address Line | PO BOX 749306
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City | ATLANTA
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State | GA
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Zip | 30374-9306
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Country | US
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Telephone | 843-556-5585
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2140
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License Number State | SC
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