Provider Demographics
NPI:1063037430
Name:KLOCH, HANNAH KELLAM (DNP)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:KELLAM
Last Name:KLOCH
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 HIGHWAY 17 N
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-6015
Mailing Address - Country:US
Mailing Address - Phone:843-238-3332
Mailing Address - Fax:
Practice Address - Street 1:1602 HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-6015
Practice Address - Country:US
Practice Address - Phone:843-238-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC240564163WG0000X
SC24116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice