Individual
MADISON BLAIRE KENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4520 BROAD ST, LORIS, SC 29569-2422
(843) 756-0959
Mailing address
4206 SEAVIEW ST APT 2, NORTH MYRTLE BEACH, SC 29582-5142
(864) 430-9948
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28278
SC
Other
Enumeration date
01/11/2024
Last updated
01/11/2024
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