Kruse, Kelly Bailey

Kruse, Kelly Bailey is an individual health care provider with primary practice located at 2093 Henry Tecklenburg Dr Ste 200 , Charleston SC 29414-5742. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as her primary health care specialty. Kruse, Kelly Bailey can be contacted via phone (843) 958-2500.

Contact Information

Primary practice address
2093 Henry Tecklenburg Dr Ste 200 Charleston SC 29414-5742
Phone: (843) 958-2500
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 496 South Carolina

Profile Details

NPI number 1942235247
LBN Legal business name Kruse, Kelly Bailey
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2006
Last updated Jun 8th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942235247 NPPES
South Carolina Other P00727284 RAILROAD MEDICARE ID-RSFPP
South Carolina Other P00615390 RAILROAD MEDICARE ID-RSFPP
South Carolina MEDICAID 0655PA RAILROAD MEDICARE ID-RSFPP

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