Individual
KATIE GARDNER NICKERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8740 RIVERS AVE, NORTH CHARLESTON, SC 29406-9211
(843) 572-5990
Mailing address
8740 RIVERS AVE, NORTH CHARLESTON, SC 29406-9211
(843) 572-5990
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-03197
NC
363AM0700X
Medical Physician Assistant
Primary
2251
SC
Other
Enumeration date
01/04/2012
Last updated
03/09/2017
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