Individual
ANGELA KELLY PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8740 RIVERS AVENUE, NORTH CHARLESTON, SC 29406
(843) 572-5990
(843) 552-4121
Mailing address
8740 RIVERS AVENUE, NORTH CHARLESTON, SC 29406
(843) 572-5990
(843) 552-4121
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
642
SC
363AM0700X
Medical Physician Assistant
642
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1805PA
—
SC
Enumeration date
12/11/2009
Last updated
08/28/2015
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