Individual
MISS KRISTEN LEIGH MAULDIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2295 HENRY TECKLENBURG DR, CHARLESTON, SC 29414-7801
(843) 766-7103
(843) 763-3834
Mailing address
2295 HENRY TECKLENBURG DR, CHARLESTON, SC 29414-7801
(843) 766-7103
(843) 763-3834
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
SC2415
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SC2415
STATE LICENSE
SC
Enumeration date
02/25/2016
Last updated
03/09/2017
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