Individual
KYLIE STOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
418 FOLLY RD, #A, CHARLESTON, SC 29412-2625
(843) 795-5362
(843) 795-1921
Mailing address
PO BOX 13955, #A, CHARLESTON, SC 29422-3955
(843) 795-5362
(843) 795-1921
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-03320
NC
363A00000X
Physician Assistant
Primary
1804
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2530PA
—
SC
05
—
8101889
—
NC
Enumeration date
01/12/2012
Last updated
08/10/2016
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