Provider Demographics
NPI:1194129643
Name:GREENFIELD, RACHEL KUEGLER (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:KUEGLER
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:MICHELLE
Other - Last Name:KUEGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:700 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4765
Mailing Address - Country:US
Mailing Address - Phone:843-383-3742
Mailing Address - Fax:
Practice Address - Street 1:701 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4777
Practice Address - Country:US
Practice Address - Phone:843-332-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2555363A00000X, 207X00000X, 207Y00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology