Tidal Pines Primary Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

TIDAL PINES PRIMARY CARE LLC

Practice address

733 Carolina Farms Blvd Ste 105
Myrtle Beach, SC 29579-3529

Phone

(843) 997-5690

NPI assigned

Oct 20, 2026

Last updated

Oct 20, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kevan Fegely, FNP-BCNPI 1891616884

Title

Owner

Phone

(843) 997-5690

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kevan Fegely, FNP-BC

  • Primary Care Nurse Practitioner
  • North Charleston, SC
  • NPI 1891616884
  Authorized official Same address or phone

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

{
    "created_epoch": "1792454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792454400000",
    "number": "1518864925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6650 RIVERS AVE STE 105",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294064829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "733 CAROLINA FARMS BLVD STE 105",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295793529",
            "telephone_number": "843-997-5690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDAL PINES PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-10-20",
        "last_updated": "2026-10-20",
        "certification_date": "2026-10-20",
        "status": "A",
        "authorized_official_last_name": "FEGELY",
        "authorized_official_first_name": "KEVAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-997-5690",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Primary Care Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2026; 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.