Provider Demographics
NPI:1689299406
Name:WEEKS, MARY KAITLIN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAITLIN
Last Name:WEEKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 E HOSPITAL DR STE 240
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4800
Mailing Address - Country:US
Mailing Address - Phone:803-936-7590
Mailing Address - Fax:803-936-7589
Practice Address - Street 1:146 E HOSPITAL DR STE 240
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4800
Practice Address - Country:US
Practice Address - Phone:803-936-7590
Practice Address - Fax:803-936-7589
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily