HOLLY PETRUSSON NPI 1417710781

NPI Information

  • NPI: 1417710781
  • Provider Name: HOLLY PETRUSSON
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1327 ASHLEY RIVER RD
    CHARLESTON, SC
    ZIP 29407
  • Phone: (843) 577-4551

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NPI Details

Holly Petrusson is a medical physician assistant in Charleston, SC with 3 years of experience. Holly Petrusson NPI is 1417710781. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1327 ASHLEY RIVER RD
CHARLESTON, SC
ZIP 29407-384
Phone: (843) 577-4551

The NPI 1417710781 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/31/2024 and was last updated on 5/29/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedical5198SOUTH CAROLINAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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