Provider Demographics
NPI:1831659770
Name:SEALS, KALEIGH ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KALEIGH
Middle Name:ELIZABETH
Last Name:SEALS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KALEIGH
Other - Middle Name:E
Other - Last Name:HUDAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 421718
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-4203
Mailing Address - Country:US
Mailing Address - Phone:843-652-8226
Mailing Address - Fax:
Practice Address - Street 1:4040 HIGHWAY 17 UNIT 202
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5098
Practice Address - Country:US
Practice Address - Phone:843-652-8392
Practice Address - Fax:843-652-8399
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3196OtherPA