Basic Information
| Provider Information | |||||||||
| NPI: | 1558853598 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEARCE | ||||||||
| FirstName: | KATIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 OAK FOREST RD STE D | ||||||||
| Address2: | |||||||||
| City: | BLUFFTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299104988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438156468 | ||||||||
| FaxNumber: | 8438156492 | ||||||||
| Practice Location | |||||||||
| Address1: | 776 2ND ST E | ||||||||
| Address2: | |||||||||
| City: | ESTILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299184926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036252548 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2018 | ||||||||
| LastUpdateDate: | 03/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 21691 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 21691 | 01 | SC | NURSING LICENSE BOARD | OTHER |