Provider Demographics
NPI:1912619883
Name:GILLARD, KAMAU CASEY (APRN)
Entity Type:Individual
Prefix:MR
First Name:KAMAU
Middle Name:CASEY
Last Name:GILLARD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:147 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:617-759-2004
Mailing Address - Fax:405-632-1976
Practice Address - Street 1:SC HOUSE CALLS INC
Practice Address - Street 2:111 DOCTORS CIRCLE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:405-632-1976
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-21
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC205520163W00000X
SC26903363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse