Provider Demographics
NPI:1386998482
Name:ERWIN, KALIE EILEEN (PA-C)
Entity type:Individual
Prefix:
First Name:KALIE
Middle Name:EILEEN
Last Name:ERWIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KALIE
Other - Middle Name:EILEEN
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:48 CROSS PARK CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4263
Practice Address - Country:US
Practice Address - Phone:864-797-7400
Practice Address - Fax:864-797-7405
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007492363A00000X
SC2342363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2244PAMedicaid
SCSC61217951Medicare PIN