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General NPI Number Information
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NPI Number | 1497997209
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Entity Type | Individual
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Provider Name | KOREY RICHARD GRAETTINGER APN
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Gender | Male
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Dates
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Enumeration Date | 03/26/2009
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 100 HEALTHY WAY STE 1120
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City | ANDERSON
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State | SC
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Zip | 29621-7915
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Country | US
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Telephone | 864-512-4530
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Fax | 864-512-4540
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Provider Business Mailing Address
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Address Line | PO BOX 100174
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City | COLUMBIA
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State | SC
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Zip | 29202-3174
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Country | US
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Telephone | 864-512-4530
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Fax | 864-512-4540
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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 | 1710I1002X
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Taxonomy Name | Independent Duty Corpsman
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License Number |
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 24327
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License Number State | SC
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