Individual provider Active NPI

Suzan M Kleckley, ANP

  • Family Nurse Practitioner
  • North Charleston, SC
National Provider Identifier
1649247685
Registry record updated Feb 27, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN2502 Issued in SC
Practice address
3815 Faber Place Dr
North Charleston, SC 29405-8533
Phone
(843) 767-9312
Fax
(843) 767-9313
NPI assigned
Mar 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2008

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 APN2502 SC Primary

Addresses

Primary practice location

3815 Faber Place Dr
North Charleston, SC 29405-8533

Mailing address

3815 Faber Place Dr
Charleston, SC 29405-8533
Phone (843) 767-9312

Other identifiers 2

IdentifierTypeStateIssuer
NP0782MedicaidSC
GP2517MedicaidSC

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)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN2502SCMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204070400000",
    "number": "1649247685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3815 FABER PLACE DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294058533",
            "telephone_number": "843-767-9312",
            "fax_number": "843-767-9313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3815 FABER PLACE DR",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294058533",
            "telephone_number": "843-767-9312",
            "fax_number": "843-767-9313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLECKLEY",
        "first_name": "SUZAN",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-08",
        "last_updated": "2008-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "APN2502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP0782",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2517",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; 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.