Provider Demographics
NPI:1649510504
Name:WALDREP, KATHY ANSLEY (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:ANSLEY
Last Name:WALDREP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 KELLY MILL RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-8726
Mailing Address - Country:US
Mailing Address - Phone:803-714-1300
Mailing Address - Fax:803-714-1301
Practice Address - Street 1:1151 KELLY MILL RD
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-8726
Practice Address - Country:US
Practice Address - Phone:803-714-1300
Practice Address - Fax:803-714-1301
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38695163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool