Individual provider Active NPI

Kristen Michelle Deupree, PA-C

  • Physician Assistant
  • Little River, SC
National Provider Identifier
1063167328
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5923 Issued in SC
Practice address
3980 Highway 9 E Ste 110
Little River, SC 29566-8163
Phone
(843) 399-3100
NPI assigned
Feb 15, 2022
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5923 SC Primary

Addresses

Primary practice location

3980 Highway 9 E Ste 110
Little River, SC 29566-8163

Mailing address

506 E Cheves St Ste 202
Florence, SC 29506-2616

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220328000310 MS Practitioner - Physician Assistant 5799170817 Reassigns benefits to 1 organization
I20250820004502 SC Practitioner - Physician Assistant 5799170817 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLeod Physician Associates IIGroup PAC ID 8224031307, 541 clinicians

Practice addresses (Care Compare)

101 McLeod Health Blvd
Suite 201
Myrtle Beach, SC 29579-4477
Phone (843) 646-8001

107 McLeod Health Blvd
Myrtle Beach, SC 29579-4477

115 McLeod Health Blvd
Myrtle Beach, SC 29579-4477

3617 Casey St
Loris, SC 29569-2981
Phone (843) 756-7090

3980 Hwy 9 E
Little River, SC 29566-8163

800 E Cheves St
Florence, SC 29506-2650

800 E Cheves St
Florence, SC 29506-2652

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medical Center Services, LLC CurrentSince Mar 1, 2022 Accepting new patients
McLeod Physician Associates II CurrentSince Jul 28, 2025 Accepting new patients
McLeod Physician Associates II CurrentSince Jul 28, 2025 Accepting new patients
McLeod Physician Associates II Past Accepting new patients

Locations

4250 S Eason Blvd
Tupelo, MS 38801
Phone (662) 377-5265

830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136

506 E Cheves St
#202
Florence, SC 29506

800 E Cheves St
Ste 240
Florence, SC 29506
Phone (843) 777-7950

800 E Cheves St
Ste 480A
Florence, SC 29506
Phone (843) 777-7337

3980 Highway 9 E
Ste 110
Little River, SC 29566
Phone (843) 366-3040

Interoperability endpoints

  • Direct secure messaging: kdeupree98513@directmcleodehealth.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1644883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1063167328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 E CHEVES ST STE 202",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295062616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3980 HIGHWAY 9 E STE 110",
            "city": "LITTLE RIVER",
            "state": "SC",
            "postal_code": "295668163",
            "telephone_number": "843-399-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEUPREE",
        "first_name": "KRISTEN",
        "middle_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-15",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "5923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little River, SC

Sources for this page

Verify at the official NPI Registry.