1770560310 NPI number — MRS. ARNELL CORETHIA KITHCART FNP

Table of content: MRS. ARNELL CORETHIA KITHCART FNP (NPI 1770560310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770560310 NPI number — MRS. ARNELL CORETHIA KITHCART FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITHCART
Provider First Name:
ARNELL
Provider Middle Name:
CORETHIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENNEGHAN
Provider Other First Name:
ARNELL
Provider Other Middle Name:
CORETHIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
III
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770560310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3404 TWIGGS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29505-5100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-673-9481
Provider Business Mailing Address Fax Number:
843-676-0984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2835 E HIGHWAY 76
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
MULLINS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29574-6038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-431-9882
Provider Business Practice Location Address Fax Number:
843-431-9879
Provider Enumeration Date:
12/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F175 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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