Provider Demographics
NPI:1750981833
Name:MCGUIGAN, KAITLYN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:MCGUIGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:SKELSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:GRAND STRAND PEDIATRICS
Mailing Address - Street 2:8120 ROURK STREET
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572
Mailing Address - Country:US
Mailing Address - Phone:843-449-1438
Mailing Address - Fax:843-286-1349
Practice Address - Street 1:GRAND STRAND PEDIATRICS
Practice Address - Street 2:1120 GLENNS BAY ROAD
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575
Practice Address - Country:US
Practice Address - Phone:843-449-1438
Practice Address - Fax:843-286-1349
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3619208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics