Provider Demographics
NPI:1033503537
Name:KAISER, LAURA B (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:B
Last Name:KAISER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:LIVERGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:BMAC CREDENTIALING
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-5674
Mailing Address - Fax:843-522-5678
Practice Address - Street 1:BEAUFORT MEMORIAL SURGICAL SPECIALISTS
Practice Address - Street 2:1680 RIBAUT RD
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2008
Practice Address - Country:US
Practice Address - Phone:843-524-8171
Practice Address - Fax:844-296-2307
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA2290OtherSTATE LICENSE BOARD
SC3783PAMedicaid