Provider Demographics
NPI:1477949774
Name:MCBRAYER, MOLLY A (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:A
Last Name:MCBRAYER
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 CHARLIE HALL BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-6099
Mailing Address - Country:US
Mailing Address - Phone:843-402-0227
Mailing Address - Fax:843-402-0232
Practice Address - Street 1:1520 OLD TROLLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5292
Practice Address - Country:US
Practice Address - Phone:843-402-0227
Practice Address - Fax:843-402-0232
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19414363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3245Medicaid