Provider Demographics
NPI:1003822693
Name:LIGON, BRENDA (MPA-C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:LIGON
Suffix:
Gender:F
Credentials:MPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-0099
Mailing Address - Country:US
Mailing Address - Phone:803-254-3278
Mailing Address - Fax:803-255-2715
Practice Address - Street 1:2001 LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1018
Practice Address - Country:US
Practice Address - Phone:803-254-3278
Practice Address - Fax:803-255-2715
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA321363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q27717Medicare UPIN