Individual
MARY LOUISE KISTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-BC
Contact information
Practice address
86 JONATHAN LUCAS ST, CHARLESTON, SC 29425-8900
(843) 792-9300
Mailing address
86 JONATHAN LUCAS ST, CHARLESTON, SC 29425-8900
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26823
SC
Other
Enumeration date
03/09/2023
Last updated
03/13/2023
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