Provider Demographics
NPI:1811739329
Name:STEVENS, KAITLIN FRAZIER (FNP)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:FRAZIER
Last Name:STEVENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:CAROL
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1838 WHISPERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-8297
Mailing Address - Country:US
Mailing Address - Phone:843-469-3514
Mailing Address - Fax:
Practice Address - Street 1:2 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6010
Practice Address - Country:US
Practice Address - Phone:843-571-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28549207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine