Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 9194 | SC |
Y | 213EG0000X | General Practice | 9194 | SC |
NPI | 1003392275 |
---|---|
Provider Name | Katelyn Nevitt |
First Address | Columbia, SC 29206-5094 |
Second Address | Columbia, SC 29203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2018 |
Last Update Date | 11/07/2018 |