Nicole Perrin Ketchin, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1073 Issued in SC

Practice address

180 Wingo Way
Suite 307
Mt Pleasant, SC 29464-1810

Phone

(843) 884-1777

NPI assigned

Jun 24, 2006

Last updated

Oct 20, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Lowcountry Medical Associates

  dba Moncks Corner Primary Care

  • Internal Medicine Physician
  • Moncks Corner, SC
  • NPI 1790735975
  NPD (past)

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445299200000",
    "number": "1093741613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751649",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751649",
            "telephone_number": "843-789-1620",
            "fax_number": "843-724-2440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 WINGO WAY",
            "address_2": "SUITE 307",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294641810",
            "telephone_number": "843-884-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETCHIN",
        "first_name": "NICOLE",
        "middle_name": "PERRIN",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-24",
        "last_updated": "2015-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "1073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0363PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kerry Wischusen Counseling & Mindfulness
• Sean Kershaw
• Amanda Kershner, OTR/L
• Allison Lou Kerwin
• Ketamine Treatment Services (Dunes West Medical Clinic)
• Kaitlin Hope Kettleson, COTA/L
• Michelle Keutzer, CRNA
• Mary Beth Keyserling-Kramer, M.ED., LPC, LMFT
• Caroline Rose Khader, CNM/WHNP
• Norman P Khoury, M.D.

• Medical Physician Assistant in Mount Pleasant, SC
• Providers in Mount Pleasant, SC by specialty
• Medical Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.