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General NPI Number Information
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NPI Number | 1821144304
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Entity Type | Individual
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Provider Name | PHYLLIS J KUTCH PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 11 JENKINS STREET
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City | MAULDIN
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State | SC
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Zip | 29662-2412
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Country | US
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Telephone | 864-288-1941
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Fax | 864-288-1946
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Provider Business Mailing Address
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Address Line | 11 JENKINS ST
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City | MAULDIN
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State | SC
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Zip | 29662-2412
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Country | US
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Telephone | 864-288-1941
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Fax | 864-288-1946
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1165
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License Number State | SC
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