Individual
NICHOLAS KENT PETRUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
22580 HIGHWAY 76 E, LAURENS, SC 29360-8460
(864) 939-1070
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3330
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3948PA
—
SC
Enumeration date
08/28/2019
Last updated
07/18/2023
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