Individual
MARIA MALATANOS KENNICKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1300 HOSPITAL DR STE 300, MOUNT PLEASANT, SC 29464-3217
(843) 884-5200
Mailing address
1300 HOSPITAL DR STE 300, MOUNT PLEASANT, SC 29464-3217
(843) 793-5182
(843) 266-5125
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2729
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2999PA
—
SC
Enumeration date
09/30/2008
Last updated
03/03/2025
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