MARIA MALATANOS KENNICKELL (NPI# 1447400171) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447400171 |
| Entity Type | Individual |
| Full Name | MARIA MALATANOS KENNICKELL |
| Credential | PA-C |
| Practice Address |
1962 Charlie Hall Blvd Charleston SC 29414-5837 |
| Mailing Address |
2001 2nd Ave Ste 101 Summerville SC 29486-7887 |
| Practice Telephone | 8437228000 |
| Practice Fax Number | 8436476066 |
| Mailing Telephone | 8437935182 |
| Mailing Fax Number | 8432665125 |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2020-05-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 2729 | SC | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | 2999PA | 05 |
| Street Address |
1962 CHARLIE HALL BLVD |
| City | CHARLESTON |
| State | SC |
| Zip Code | 29414-5837 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891791372 | William Brener | Specialist | 1962 Charlie Hall Blvd, Charleston, SC 29414-5837 | 2005-06-21 |
| 1194231761 | Charleston Gastroenterology Specialists | Anesthesiology | 1962 Charlie Hall Blvd, Charleston, SC 29414-5837 | 2017-12-19 |
| 1922447739 | Richard Allan Schatz | Internal Medicine | 1962 Charlie Hall Blvd, Charleston, SC 29414-5837 | 2013-06-14 |
| 1790046373 | Ankit Vibhash Patel | Internal Medicine | 1962 Charlie Hall Blvd, Charleston, SC 29414 | 2012-05-31 |
| 1972884070 | Deborah Ann Damaskos | Nurse Practitioner | 1962 Charlie Hall Blvd, Charleston, SC 29414-5837 | 2011-09-01 |
| 1437393964 | Jeffrey M Basile | Internal Medicine | 1962 Charlie Hall Blvd, Charleston, SC 29414 | 2009-04-28 |
| 1417173378 | Nathan Joseph Shores | Internal Medicine | 1962 Charlie Hall Blvd, Charleston, SC 29414 | 2007-04-18 |
| 1609984566 | Christopher Lawrence | Internal Medicine | 1962 Charlie Hall Blvd, Charleston, SC 29414-5837 | 2006-08-29 |
| 1154386639 | Robert Sidney Green Smith | Internal Medicine | 1962 Charlie Hall Blvd, Charleston, SC 29414-5837 | 2006-04-19 |
| 1619930807 | Marc D Noble | Specialist | 1962 Charlie Hall Blvd, Charleston, SC 29414-5837 | 2006-04-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902444508 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 3865 West Ashley Circle, Charleston, SC 29414 | 2019-12-13 |
| 1215440169 | Christine Michelle Delcioppo | Nurse Practitioner | 2085 Henry Tecklenburg Dr Fl 2or2, Charleston, SC 29414 | 2017-11-14 |
| 1871013508 | Carolyn Sorenson | Assistant Behavior Analyst | 2218 Hunter Creek Dr, Charleston, SC 29414 | 2017-06-23 |
| 1205387354 | Rachel Klatt | Physical Therapist | 2230 Ashley Crossing Dr., Charleston, SC 29414 | 2016-10-24 |
| 1295286912 | Mary M Butler | Physical Therapy Assistant | 2230 Ashley Crossing Drive, Charleston, SC 29414 | 2016-10-18 |
| 1295104982 | Charlene Barbot | Registered Nurse | 3741 Clover St, Charleston, SC 29414 | 2015-09-23 |
| 1720467525 | Sasha M. Perez | Family Medicine | 3030 Ashley Town Center Dr Ste 102a, Charleston, SC 29414 | 2015-05-26 |
| 1104226240 | Angela Mcinvale | Counselor | 3030 Ashley Town Center Dr., Bldg. B-203, Charleston, SC 29414 | 2014-08-26 |
| 1659790087 | Catherine Jefferson Vanderwerker | Physical Therapist | 3019 Saintsbury Cove Dr, Charleston, SC 29414 | 2014-04-14 |
| 1104266741 | Elizabeth A Burguieres | Psychiatry & Neurology | Scdmh- Charleston Telepsychiatry Office, 706 Orleans Rd, Charleston, SC 29414 | 2013-06-27 |
| Find all providers in zip 29414 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475326 | Rebecca Whealen | Physician Assistant | 2026 Huber Rd, Charleston, WV 25314-2236 | 2020-10-23 |
| 1275131054 | Ethan Brody Clontz | Physician Assistant | 1953 Pinehurst Ave, Charleston, SC 29414-6483 | 2020-10-13 |
| 1386251635 | Caitlin Estep | Physician Assistant | 3100 Maccorkle Ave Se Ste 802, Charleston, WV 25304-1233 | 2020-09-29 |
| 1487261509 | Reilly Kilpatrick | Physician Assistant | 1518 Blaze Ln, Charleston, SC 29412-8652 | 2020-09-24 |
| 1083228514 | Andrea Denise Boan | Physician Assistant | 12 Commercial Row Apt A, Charleston, SC 29412-3641 | 2020-09-02 |
| 1194343673 | Andrew N Brewer | Physician Assistant | 171 Ashley Ave Ste 419, Charleston, SC 29425-8908 | 2020-07-10 |
| 1396361309 | Jacquelyn Joseph | Physician Assistant | 134 Howard Mary Dr Apt A, Charleston, SC 29412-9581 | 2020-06-25 |
| 1639719990 | Jessy Marie Hamrick | Physician Assistant | 149 Dutch Rd Apt 105, Charleston, WV 25302-2530 | 2020-01-14 |
| 1093355521 | Virginia Noemi Escobar-cheng | Physician Assistant | 310 Red Mulberry Way Apt 3, Charleston, WV 25306-6395 | 2020-01-13 |
| 1598300279 | Breanne Marie Wiekamp | Physician Assistant | 20 Scarlet Oak Ln Apt 3, Charleston, WV 25306-1128 | 2019-11-17 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 29414 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.