Provider Demographics
NPI:1881576502
Name:MOZINGO, KAITLYN ROBERTS (FNP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ROBERTS
Last Name:MOZINGO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 EDGELAND RD
Mailing Address - Street 2:
Mailing Address - City:EDGEMOOR
Mailing Address - State:SC
Mailing Address - Zip Code:29712-7734
Mailing Address - Country:US
Mailing Address - Phone:864-321-7318
Mailing Address - Fax:
Practice Address - Street 1:2633 CELANESE RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1205
Practice Address - Country:US
Practice Address - Phone:803-325-1770
Practice Address - Fax:803-325-1790
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30720363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care