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:
Health care specialties
| Specialty | Code | License # | 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 3 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| 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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