Active NPI
Suzan M Kleckley, ANP
- Family Nurse Practitioner
- North Charleston, SC
National Provider Identifier
1649247685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- APN2502
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NP0782 | Medicaid | SC | |
| GP2517 | Medicaid | SC |
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
| License | State | Type | Specialty |
|---|---|---|---|
| APN2502 | SC | MD | Family 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.