Provider Demographics
NPI:1073161634
Name:SIMS, WHITNEY LENORE (PA-C)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LENORE
Last Name:SIMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WILLIAM H JOHNSON ST STE 600
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2773
Mailing Address - Country:US
Mailing Address - Phone:843-667-1891
Mailing Address - Fax:843-665-2516
Practice Address - Street 1:101 WILLIAM H JOHNSON ST STE 600
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2773
Practice Address - Country:US
Practice Address - Phone:843-667-1891
Practice Address - Fax:843-665-2516
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3303363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3355PAMedicaid