Individual
MS. KELSEY BAIZAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA, RD
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-6000
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3280
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3842PA
—
SC
01
—
SCF8715019
MEDICARE PIN
SC
01
—
SCF8719068
MEDICARE PIN
SC
Enumeration date
05/06/2019
Last updated
11/19/2020
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