Provider Demographics
NPI:1043071145
Name:AUTRY, JOY RENEE (RN, CLC)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:RENEE
Last Name:AUTRY
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CADDIS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8138
Mailing Address - Country:US
Mailing Address - Phone:803-351-1107
Mailing Address - Fax:
Practice Address - Street 1:113 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3449
Practice Address - Country:US
Practice Address - Phone:803-704-4759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC255588163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant