Provider Demographics
NPI:1013372390
Name:FARR, ERIN LAVETTE (NP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LAVETTE
Last Name:FARR
Suffix:
Gender:F
Credentials:NP
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 23328
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29224-3328
Mailing Address - Country:US
Mailing Address - Phone:803-722-4988
Mailing Address - Fax:
Practice Address - Street 1:140 WILDEWOOD PARK DR STE 107
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4312
Practice Address - Country:US
Practice Address - Phone:803-722-4988
Practice Address - Fax:803-656-8135
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3691Medicaid
SCSC75427951Medicare PIN