Provider Demographics
NPI:1497171425
Name:SMITH, PAMELA J (RN/APRN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN/APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4941
Mailing Address - Country:US
Mailing Address - Phone:803-773-5511
Mailing Address - Fax:
Practice Address - Street 1:105 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4941
Practice Address - Country:US
Practice Address - Phone:803-773-5511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34862163WC1500X
SCAPN-TP 19170363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily