Provider Demographics
NPI:1477592178
Name:BURGESS, STEPHANIE E (APRN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:BURGESS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:STRANGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 5731
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29250-5731
Mailing Address - Country:US
Mailing Address - Phone:803-256-2500
Mailing Address - Fax:803-758-1726
Practice Address - Street 1:1410 BLANDING ST STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2967
Practice Address - Country:US
Practice Address - Phone:803-256-2500
Practice Address - Fax:803-758-1726
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFNP001Medicaid
S11385Medicare UPIN
SCS113853357Medicare PIN
SCS113856580Medicare PIN
SCFNP001Medicaid