Provider Demographics
NPI:1790027464
Name:KAO, ANNETTE (FNP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:KAO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LANDSTONE CT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3687
Mailing Address - Country:US
Mailing Address - Phone:864-363-3636
Mailing Address - Fax:
Practice Address - Street 1:135 COMMONWEALTH DR STE 120
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4881
Practice Address - Country:US
Practice Address - Phone:864-675-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22230363LF0000X
SC213514163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse