Provider Demographics
NPI:1730587262
Name:STEEDLY, KELSEY N (PA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:N
Last Name:STEEDLY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:R
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:201 SIGMA DR
Mailing Address - Street 2:STE 100
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7715
Mailing Address - Country:US
Mailing Address - Phone:843-572-7727
Mailing Address - Fax:843-569-5895
Practice Address - Street 1:7 S ALLIANCE DR STE 202A
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7269
Practice Address - Country:US
Practice Address - Phone:843-376-0670
Practice Address - Fax:843-376-0669
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2229363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2056PAMedicaid
SC2056PAMedicaid