Individual
STACI LEIGH CASSIDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1268 S 4TH ST, HARTSVILLE, SC 29550-0703
(843) 332-3422
(843) 332-3985
Mailing address
PO BOX 1090, HARTSVILLE, SC 29551-1090
(843) 337-7553
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
24579
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP7760
—
SC
01
—
SCL032
MEDICARE
—
Enumeration date
04/21/2021
Last updated
03/18/2024
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