Individual
KELSIE CHANDLER REQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2863 N HIGHWAY 17, MOUNT PLEASANT, SC 29466-8962
(843) 572-5990
Mailing address
304 ALWYN BLVD, SUMMERVILLE, SC 29485-4000
(843) 412-2053
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/04/2018
Last updated
09/04/2018
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