Moody, Kacie Jo Costello
Moody, Kacie Jo Costello is an individual health care provider with primary practice located at 704 Gold Hill Rd Suite 1200, Fort Mill SC 29715-8906. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Moody, Kacie Jo Costello can be contacted via phone (704) 667-3380.Contact Information
Primary practice address
704 Gold Hill Rd Suite 1200
Fort Mill SC 29715-8906
Phone: (704) 667-3380
Fax: (704) 667-3381
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 0010-00779 | North Carolina |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 1295 | South Carolina |
Profile Details
| NPI number | 1841461373 |
|---|---|
| LBN Legal business name | Moody, Kacie Jo Costello |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 12th, 2008 |
| Last updated | Jul 21st, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841461373 | NPPES |
| South Carolina | MEDICAID | 0640PA | |
| South Carolina | MEDICAID | 1841461373 |
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