Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kacie Jo Costello Moody, PA

Individual provider Physician Assistant · NPI 1841461373

Kacie Jo Costello Moody, PA is a Physician Assistant in Fort Mill, South Carolina. Graduated from Medical University of South Carolina College of Medicine in 2006, 20 years ago. Practices with Premier Medical of SC LLC, a 6-clinician group and accepts Medicare assignment. Licensed in North Carolina and South Carolina.

Years since qualifying
20
Trained at
Medical University of South Carolina College of Medicine
Licensed in
NC, SC
In the registry since
2008
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

704 Gold Hill Rd Ste 1200
Fort Mill, SC 29715-8906
Phone: (704) 667-3380
Fax: (704) 667-3381
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 1295 (SC)
Physician Assistant Taxonomy 363A00000X · Licence 0010-00779 (NC)

Record details

NPI number1841461373
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedMarch 12, 2008
Last updated in NPPESJuly 21, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolMEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE
Graduated 2006 (20 years in practice)
Group practice Premier Medical Of Sc Llc — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Fort Mill