Provider Demographics
NPI:1013439421
Name:KINDY, KARISA KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:KARISA
Middle Name:KAY
Last Name:KINDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 HARRISON BRIDGE RD STE B
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7133
Mailing Address - Country:US
Mailing Address - Phone:864-603-5600
Mailing Address - Fax:
Practice Address - Street 1:312 HARRISON BRIDGE RD STE B
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-7133
Practice Address - Country:US
Practice Address - Phone:864-603-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2791363AM0700X, 363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical