Individual
MS. PHYLLIS J KUTCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11 JENKINS STREET, MAULDIN, SC 29662-2412
(864) 288-1941
(864) 288-1946
Mailing address
11 JENKINS ST, MAULDIN, SC 29662-2412
(864) 288-1941
(864) 288-1946
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1165
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0506PA
—
SC
01
—
8272
MEDICARE GROUP NUMBER
SC
01
—
GP4225
MEDICAID GROUP NUMBER
SC
Enumeration date
01/26/2007
Last updated
12/06/2007
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