Provider Demographics
NPI:1336362433
Name:GIET, KRISTEN RENAUD (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:RENAUD
Last Name:GIET
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9267 MEDICAL PLAZA DR
Mailing Address - Street 2:STE G
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9139
Mailing Address - Country:US
Mailing Address - Phone:843-797-3636
Mailing Address - Fax:843-797-3637
Practice Address - Street 1:9267 MEDICAL PLAZA DR
Practice Address - Street 2:STE G
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9139
Practice Address - Country:US
Practice Address - Phone:843-797-3636
Practice Address - Fax:843-797-3637
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1190363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1190OtherSTATE LICENSE
SC1190OtherSTATE LICENSE
SCAA22017439Medicare PIN