Provider Demographics
NPI:1336327741
Name:KEARNEY, CHRISTOPHER A (RPAC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:A
Last Name:KEARNEY
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:MR
Other - First Name:C
Other - Middle Name:A
Other - Last Name:KEARNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPAC
Mailing Address - Street 1:210 VILLAGE CENTER BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-6706
Mailing Address - Country:US
Mailing Address - Phone:843-353-3460
Mailing Address - Fax:843-353-3460
Practice Address - Street 1:2376 CYPRESS CIR
Practice Address - Street 2:STE 300
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8995
Practice Address - Country:US
Practice Address - Phone:631-205-1643
Practice Address - Fax:631-205-1643
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1753363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1928PAMedicaid
SC1928PAMedicaid