Provider Demographics
NPI:1942773866
Name:ST. GERMAIN, KIELY MCCREA (APRN)
Entity Type:Individual
Prefix:
First Name:KIELY
Middle Name:MCCREA
Last Name:ST. GERMAIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KIELY
Other - Middle Name:PADDOCK
Other - Last Name:MCCREA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9228 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9125
Mailing Address - Country:US
Mailing Address - Phone:843-574-5693
Mailing Address - Fax:843-764-4512
Practice Address - Street 1:9228 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9125
Practice Address - Country:US
Practice Address - Phone:843-574-5693
Practice Address - Fax:843-764-4512
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22185363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily