MEDICARE: KRISTIN MARIE WORGESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	5601006445	MI
2	363A00000X	Physician Assistant	5612	SC
3	363A00000X	Physician Assistant	5601006445	MI

General Provider Information

NPI Number	:	1215287776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN MARIE WORGESS

Provider Business Mailing Address
First Line	:	PO BOX 602441
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-2441
Country	:	US
Telephone Number	:	843-402-5200
Fax Number	:	843-402-5296

Provider Business Practice Location Address
First Line	:	3500 HIGHWAY 17 BYP N
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29466-9123
Country	:	US
Telephone Number	:	843-606-7000
Fax Number	:	843-606-7923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2012
Last Update Date	:	12/11/2025

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Directions to “ KRISTIN MARIE WORGESS ” Practice Location

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