Phyllis J Kutch, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA1165 Issued in SC

Practice address

11 Jenkins Street
Mauldin, SC 29662-2412

Phone

(864) 288-1941

Fax

(864) 288-1946

NPI assigned

Jan 26, 2007

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196899200000",
    "number": "1821144304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 JENKINS ST",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296622412",
            "telephone_number": "864-288-1941",
            "fax_number": "864-288-1946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 JENKINS STREET",
            "city": "MAULDIN",
            "state": "SC",
            "postal_code": "296622412",
            "telephone_number": "864-288-1941",
            "fax_number": "864-288-1946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUTCH",
        "first_name": "PHYLLIS",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "PA1165",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0506PA",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP NUMBER",
            "identifier": "GP4225",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "8272",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allison Kingsland
• Nicole Marie Kizer, NP
• Casey Wooten Knight, COTA/L
• Alyson Krahl, MA, LPC
• Balasubramanyam Krishniah, M.D.
• Race Land Jr.
• Nhi Le
• Elizabeth Ledda
• Jay B Leidy, DC
• Jamelah Patrice Lemon, DPM

• Medical Physician Assistant in Mauldin, SC
• Providers in Mauldin, 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 Dec 6, 2007; 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.