Individual
STACY GAILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
109 W MAIN ST, MONCKS CORNER, SC 29461-2673
(843) 719-4600
Mailing address
411 FARMERS MARKET RD, SAINT GEORGE, SC 29477-8290
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
20150
SC
163WC1500X
Community Health Registered Nurse
20150
SC
363LA2200X
Adult Health Nurse Practitioner
Primary
20150
SC
Other
Enumeration date
01/23/2017
Last updated
06/28/2023
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