Provider Demographics
NPI:1902264062
Name:HAMM, ALLISON D (APRN)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:D
Last Name:HAMM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:KEENEY-KAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 SIGMA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7722
Mailing Address - Country:US
Mailing Address - Phone:843-871-9440
Mailing Address - Fax:843-871-5932
Practice Address - Street 1:809 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6605
Practice Address - Country:US
Practice Address - Phone:843-871-9440
Practice Address - Fax:843-871-5932
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC4116Medicaid
SC423828OtherMEDICARE
SC428926OtherMEDICARE
SCNP5017Medicaid
SCRHC020Medicaid
SCRHC151Medicaid