Individual
MARY KATHRYN DICKSON STAUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
104 ELLETT RD, CHAPIN, SC 29036-8604
(803) 941-8095
Mailing address
1017 LIGHTHOUSE RD, CHAPIN, SC 29036-8590
(803) 606-5072
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4657
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4657
SOUTH CAROLINA PHYSICIAN ASSISTANT LICENSE NUMBER
SC
Enumeration date
10/21/2022
Last updated
11/12/2025
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