Provider Demographics
NPI:1578162483
Name:WAITS, KACIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KACIE
Middle Name:
Last Name:WAITS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MELVIN LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29697-9363
Mailing Address - Country:US
Mailing Address - Phone:864-847-3200
Mailing Address - Fax:
Practice Address - Street 1:107 MELVIN LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:SC
Practice Address - Zip Code:29697-9363
Practice Address - Country:US
Practice Address - Phone:864-847-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC205133163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse