Provider Demographics
NPI:1447613906
Name:AUSTIN, STAR (AG-NP)
Entity Type:Individual
Prefix:DR
First Name:STAR
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:AG-NP
Other - Prefix:
Other - First Name:STAR
Other - Middle Name:
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, CCRN, PCCN
Mailing Address - Street 1:300 CALLEN BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-8460
Mailing Address - Country:US
Mailing Address - Phone:854-529-3001
Mailing Address - Fax:843-606-8113
Practice Address - Street 1:300 CALLEN BLVD STE 330
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461
Practice Address - Country:US
Practice Address - Phone:854-529-3001
Practice Address - Fax:843-606-8113
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC92132363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4462Medicaid