Provider Demographics
NPI:1841680386
Name:MCDANIELS, KATIE (MSN ED, CDCES)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MCDANIELS
Suffix:
Gender:F
Credentials:MSN ED, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 HALTON RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3405
Mailing Address - Country:US
Mailing Address - Phone:864-331-3230
Mailing Address - Fax:864-236-1634
Practice Address - Street 1:373 HALTON RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3405
Practice Address - Country:US
Practice Address - Phone:864-331-3230
Practice Address - Fax:864-236-1634
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC215694163W00000X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse