MEDICARE: KIFTEN STEPHENS CARROLL NP

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	363LF0000X	Family Nurse Practitioner	F4231	SC

General Provider Information

NPI Number	:	1780999128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIFTEN STEPHENS CARROLL NP

Provider Business Mailing Address
First Line	:	PO BOX 751461
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1461
Country	:	US
Telephone Number	:	843-792-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 ASHLEY AVE
Second Line	:	SUITE 417 CSB
City	:	CHARLESTON
State	:	SC
Zip	:	29425-6130
Country	:	US
Telephone Number	:	843-792-7127
Fax Number	:

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

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	01/23/2017

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