Provision Healthcare, LLC
Nurse Practitioner, Family in Columbia, SC. Organization (NPI-2).
NPI number1669968152
StatusActive
Last updated in NPPESJul 8, 2018
Details
- NPI
- 1669968152
- Entity type
- Organization (NPI-2)
- Legal business name
- Provision Healthcare, LLC
- Organization subpart
- No
- Enumeration date
- Jul 8, 2018
- Last updated
- Jul 8, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | BL015940-07-2018 | SC | Yes |
Practice location
1320 Main St Ste 300Columbia, SC 29201-3266
Phone 803-373-0063
Mailing address
4611 Hard Scrabble Rd Ste 178Columbia, SC 29229-8584
Phone 803-302-8205
Other practice locations
4611 Hard Scrabble Rd Ste 178
Columbia, SC 29229-8584
Columbia, SC 29229-8584
Phone 803-373-0063
10120 Two Notch Rd # 133
Columbia, SC 29223-4395
Columbia, SC 29223-4395
Phone 803-373-0063
Authorized official
Lashonda S Tyler
Owner
8033028205
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