Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 18395 | SC |
NPI | 1003258864 |
---|---|
Provider Name | Kristen Slagel Garrett |
First Address | Charleston, SC 29414-5834 |
Second Address | Charleston, SC 29414-5834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2013 |
Last Update Date | 19/08/2013 |