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Karissa Lena Maria Charles

Student in an Organized Health Care Education/Training Program

Student, Health Care

809 82nd Pkwy, Myrtle Beach, SC 29572-4607

PECOS Enrollment

This provider is enrolled in PECOS as KARISSA CHARLES.

Based on the most recent information from CMS, provider Karissa Lena Maria Charles is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 11:05 AM.

Profile Details

Provider ID
1104528462
Provider Type
Individual
Full Name
Charles, Karissa Lena Maria
Gender
Female

Sole Proprietor
No
Enumeration Date
3/20/2023
Last Updated
3/21/2023

Contact Information

Practice Location

809 82nd Pkwy, Myrtle Beach, SC 29572-4607

(843) 692-3497

(843) 692-1122

Mailing Location

809 82nd Pkwy, Myrtle Beach, SC 29572-4607

(843) 692-3497

(843) 692-1122

Provider Taxonomies

Code	Description	License
Code 390200000X Primary	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Karissa Lena Maria Charles

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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Ogbomoh, Evelyn Nwangulor

Jardak, Christina L

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Nguyen, Kim Thien

Mejia, Christopher

Moncada, Isabella

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