Provider Demographics
NPI:1194149161
Name:BRITTON, KALLIE GRAHAM (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KALLIE
Middle Name:GRAHAM
Last Name:BRITTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KALLIE
Other - Middle Name:
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 3439
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-0439
Mailing Address - Country:US
Mailing Address - Phone:843-839-4447
Mailing Address - Fax:855-723-6342
Practice Address - Street 1:945 82ND PKWY
Practice Address - Street 2:SUITE 3B
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4612
Practice Address - Country:US
Practice Address - Phone:843-839-1201
Practice Address - Fax:843-839-1202
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2061363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant