Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 20411 | SC |
NPI | 1003363078 |
---|---|
Provider Name | Miss Karen Mccain |
First Address | Atlanta, GA 30374-3904 |
Second Address | Columbia, SC 29203-6862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2016 |
Last Update Date | 28/03/2018 |