Provider Demographics
NPI:1225314560
Name:LANCE, KATHLEEN MARIE (APN)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:LANCE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:EARNEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:255 N HIGHWAY 52
Mailing Address - Street 2:SUITE #8
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-3927
Mailing Address - Country:US
Mailing Address - Phone:843-899-9420
Mailing Address - Fax:843-899-9421
Practice Address - Street 1:255 N HIGHWAY 52
Practice Address - Street 2:SUITE #8
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-3927
Practice Address - Country:US
Practice Address - Phone:843-899-9420
Practice Address - Fax:843-899-9421
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009043363L00000X
SCAPN19005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner