Provider Demographics
NPI:1508249772
Name:STRAUP, KATLYN M (DNP)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:M
Last Name:STRAUP
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:M
Other - Last Name:CHACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:319 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2518
Practice Address - Country:US
Practice Address - Phone:843-203-2246
Practice Address - Fax:843-203-2247
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3331Medicaid
SCSC64787499Medicare PIN
SCSC64786882Medicare PIN
SCSC64786834Medicare PIN
SCSC64786868Medicare PIN
SCSC64785277Medicare PIN
SCSC64787522Medicare PIN
SCSC64787819Medicare PIN
SCNP3331Medicaid
SCSC64785282Medicare PIN
SCSC64787006Medicare PIN
SCSC64785281Medicare PIN
SCSC64788798Medicare PIN
SCSC64787126Medicare PIN