Provider Demographics
NPI:1811390313
Name:HAYDEN, KATHERINE MOREDOCK (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MOREDOCK
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:R
Other - Last Name:MOREDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 12810
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4019
Mailing Address - Country:US
Mailing Address - Phone:843-797-5050
Mailing Address - Fax:843-797-3633
Practice Address - Street 1:1175 COOK RD STE 215
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8201
Practice Address - Country:US
Practice Address - Phone:803-395-3837
Practice Address - Fax:803-536-5122
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2190363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP6337OtherARCIS HEALTHCARE MEDICAID GROUP NO.
SC1902246077OtherARCIS HEALTHCARE GROUP NPI NO.
SCD043OtherARCIS HEALTHCARE MEDICARE GROUP PTAN
SCDU4331OtherARCIS HEALTHCARE RAILROAD MEDICARE GROUP PTAN
SCDU4331OtherARCIS HEALTHCARE RAILROAD MEDICARE GROUP PTAN