Individual
KASSANDRA JEAN CARPENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
809 82ND PKWY, MYRTLE BEACH, SC 29572-4607
(843) 692-1062
Mailing address
809 82ND PKWY, MYRTLE BEACH, SC 29572-4607
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
TL49
SC
Other
Enumeration date
01/04/2016
Last updated
05/31/2023
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