MEDICARE: MRS. KECIA GADDIST CNA

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	376K00000X	Nurse's Aide	4100040419	SC

General Provider Information

NPI Number	:	1578137709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KECIA GADDIST CNA

Provider Business Mailing Address
First Line	:	4660 RIVER RD
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-8833
Country	:	US
Telephone Number	:	843-806-7177
Fax Number	:

Provider Business Practice Location Address
First Line	:	4660 RIVER RD
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-8833
Country	:	US
Telephone Number	:	843-806-7177
Fax Number	:

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

Provider Enumeration Date	:	05/12/2021
Last Update Date	:	05/12/2021

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Directions to “ MRS. KECIA GADDIST CNA” Practice Location

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