Provider Demographics
NPI:1497857668
Name:SMITH, BARBARA JEAN (MSN, APRN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 TARRYTOWN LN
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-3525
Mailing Address - Country:US
Mailing Address - Phone:803-794-5535
Mailing Address - Fax:
Practice Address - Street 1:298 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9443
Practice Address - Country:US
Practice Address - Phone:864-885-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF922OtherPRESCRIPTIVE AUTHORITY
SCNP0600Medicaid
SC54-00274OtherSC CONTROL SUBSTANCE
SCAPN 922OtherSTATE NURSING LICENSE
SCMSO470512OtherDEA