Provider Demographics
NPI:1699662809
Name:KACZMAREK, ASHLEY RENEE (RN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:RENEE
Last Name:KACZMAREK
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 1:3003 SWEETWATER LN
Mailing Address - Street 2:
Mailing Address - City:AWENDAW
Mailing Address - State:SC
Mailing Address - Zip Code:29429-6309
Mailing Address - Country:US
Mailing Address - Phone:636-222-1708
Mailing Address - Fax:
Practice Address - Street 1:3500 HIGHWAY 17 BYP N
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-9123
Practice Address - Country:US
Practice Address - Phone:843-606-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC239371163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency