Provider Demographics
NPI:1336327741
Name:KEARNEY, CHRISTOPHER ANDREW (RPAC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ANDREW
Last Name:KEARNEY
Suffix:
Gender:
Credentials:RPAC
Other - Prefix:MR
Other - First Name:C
Other - Middle Name:A
Other - Last Name:KEARNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPAC
Mailing Address - Street 1:2376 CYPRESS CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8995
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2376 CYPRESS CIR
Practice Address - Street 2:STE 300
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8995
Practice Address - Country:US
Practice Address - Phone:631-205-1643
Practice Address - Fax:631-205-1643
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1753363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1928PAMedicaid
SC1928PAMedicaid