Provider Demographics
NPI:1407340094
Name:SUMPTER, PRINSCILLIA DENISE
Entity Type:Individual
Prefix:MRS
First Name:PRINSCILLIA
Middle Name:DENISE
Last Name:SUMPTER
Suffix:
Gender:F
Credentials:
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 9
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29476-0009
Mailing Address - Country:US
Mailing Address - Phone:843-518-7238
Mailing Address - Fax:
Practice Address - Street 1:109 CHILDREN LANE
Practice Address - Street 2:
Practice Address - City:ST. STEPHENS
Practice Address - State:SC
Practice Address - Zip Code:29476
Practice Address - Country:US
Practice Address - Phone:843-518-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC124100313M00000X, 376K00000X
SC171M00000X, 172V00000X, 251E00000X, 251B00000X
SC116708253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC80-0204696OtherNO MEDICAL PROVIDER