=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649747072
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS KEYATTA BIGSBY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2018
-----------------------------------------------------
Last Update Date | 10/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 76 SWEETBRIAR LN
-----------------------------------------------------
City | SPARTANBURG
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29301-3629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-529-4250
-----------------------------------------------------
Fax | 864-283-0647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 25 WOODS LAKE RD STE 410
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29607-2764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-200-2796
-----------------------------------------------------
Fax | 864-283-0647
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------