Provider Demographics
NPI:1275991309
Name:PROCTOR, FREEDOM LEE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:FREEDOM
Middle Name:LEE
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:FREEDOM
Other - Middle Name:LEE
Other - Last Name:DEFELICE, BEVINGTON-PROCTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:743 IRISH GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CLOVER
Mailing Address - State:SC
Mailing Address - Zip Code:29710-6076
Mailing Address - Country:US
Mailing Address - Phone:724-712-6880
Mailing Address - Fax:
Practice Address - Street 1:4724 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:CLOVER
Practice Address - State:SC
Practice Address - Zip Code:29710-8095
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015911363LF0000X
SC24909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily