Provider Demographics
NPI:1083003065
Name:SIMS, STEPHANIE LAYNE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LAYNE
Last Name:SIMS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:DOWLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:101 E WOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3040
Mailing Address - Country:US
Mailing Address - Phone:864-569-7048
Mailing Address - Fax:864-560-7353
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-569-7048
Practice Address - Fax:864-560-7353
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3096Medicaid
SCSC51559068OtherMEDICARE
SCSC5155J577OtherMEDICARE PIN
SCSC51556067OtherMEDICARE PIN
SCSC51556084OtherMEDICARE PIN
SCSC51558510OtherMEDICARE