Active NPI
Kerrion Green
- Family Nurse Practitioner
- Indian Land, SC
National Provider Identifier
1043010002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 30014
- Practice address
- 1040 Edgewater Corporate Pkwy Ste 101
Indian Land, SC 29707-4526 - Phone
- (803) 548-7007
- NPI assigned
- Mar 18, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 30014 | SC | Primary |
Addresses
Primary practice location
1040 Edgewater Corporate Pkwy Ste 101
Indian Land, SC 29707-4526
Mailing address
1040 Edgewater Corporate Pkwy Ste 101
Indian Land, SC 29707-4526
Phone (803) 548-7007
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1742256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742256000000",
"number": "1043010002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1040 EDGEWATER CORPORATE PKWY STE 101",
"city": "INDIAN LAND",
"state": "SC",
"postal_code": "297074526",
"telephone_number": "803-548-7007"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 EDGEWATER CORPORATE PKWY STE 101",
"city": "INDIAN LAND",
"state": "SC",
"postal_code": "297074526",
"telephone_number": "803-548-7007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "KERRION",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-03-18",
"last_updated": "2025-03-18",
"certification_date": "2025-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "SC",
"license": "30014",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indian Land, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.