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Individual provider Active NPI

Kacie Nicole Tyner, FNP-C

  • Family Nurse Practitioner
  • Greenville, SC
National Provider Identifier
1528781127
Registry record updated Nov 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26419 Issued in SC
Practice address
701 Grove Rd
Greenville, SC 29605-4210
Phone
(864) 455-5648
Fax
(864) 455-7862
NPI assigned
Sep 20, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 26419 SC Primary

Addresses

Primary practice location

701 Grove Rd
Greenville, SC 29605-4210

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

876 W Faris Rd
Greenville, SC 29605-4253
Phone (864) 455-8929

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221118001841 SC Practitioner - Nurse Practitioner 0143698332 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anderson ENT PAGroup PAC ID 2062429541, 2 clinicians

Practice addresses (Care Compare)

1206 Cornelia Rd
Anderson, SC 29621-3349
Phone (864) 226-2822

210 Freeman Farm Rd
Duncan, SC 29334-9398
Phone (864) 968-5123

701 Grove Rd
Greenville, SC 29605-4210

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26419SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group CurrentSince Nov 20, 2022 Accepting new patients
Anderson ENT, PA CurrentSince Oct 6, 2025 Accepting new patients
Prisma Health University Medical Group Current Accepting new patients
Prisma Health University Medical Group CurrentSince Nov 20, 2022 Accepting new patients

Locations

1206 Cornelia Rd
Anderson, SC 29621
Phone (864) 224-5349

210 Freeman Farm Rd
Duncan, SC 29334
Phone (864) 968-5123

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

701 Grove Rd
Greenville, SC 29605
Phone (864) 454-2030

Interoperability endpoints

  • Direct secure messaging: ktyner129012@direct.ghs.myhfn.org

Organizations & group practices 4

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

Hospital & facility affiliations 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1663632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668038400000",
    "number": "1528781127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 GROVE RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054210",
            "telephone_number": "864-455-5648",
            "fax_number": "864-455-7862"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "876 W Faris Rd",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296054253",
            "country_code": "US",
            "telephone_number": "864-455-8929",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TYNER",
        "first_name": "KACIE",
        "middle_name": "NICOLE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-20",
        "last_updated": "2022-11-10",
        "certification_date": "2022-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "26419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

Verify at the official NPI Registry.