Provider Demographics
NPI:1831186360
Name:TEGTMEYER, DARRELL KEVIN (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:KEVIN
Last Name:TEGTMEYER
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:613 BART BELLAMY LN
Mailing Address - Street 2:
Mailing Address - City:COTTAGEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29435-3034
Mailing Address - Country:US
Mailing Address - Phone:843-321-5927
Mailing Address - Fax:
Practice Address - Street 1:10160 DORCHESTER ROAD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8527
Practice Address - Country:US
Practice Address - Phone:843-871-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2822363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical