Individual
KELLY PADGETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 RIVER BOTTOM RD, IRMO, SC 29063-8630
(803) 476-8258
Mailing address
1 RIVER BOTTOM RD, IRMO, SC 29063-8630
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
74895
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74895
—
SC
Enumeration date
11/04/2013
Last updated
11/04/2013
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