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General NPI Number Information
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NPI Number | 1891616884
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Entity Type | Individual
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Provider Name | KEVAN FEGELY
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Gender | Female
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Dates
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Enumeration Date | 07/24/2026
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Last Update Date | 07/24/2026
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Provider Practice Location Address
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Address Line | 3874 RENEE DR UNIT D
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-4358
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Country | US
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Telephone | 843-903-4500
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Fax | 843-903-4505
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Provider Business Mailing Address
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Address Line | 3874 RENEE DR UNIT D
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-4358
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Country | US
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Telephone | 843-903-4500
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Fax | 843-903-4505
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 245720
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License Number State | SC
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