Provider Demographics
NPI:1518001478
Name:PATTERSON, GAYLA WILSON (NP)
Entity Type:Individual
Prefix:
First Name:GAYLA
Middle Name:WILSON
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HEALTHY WAY
Mailing Address - Street 2:SUITE 1250
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-7915
Mailing Address - Country:US
Mailing Address - Phone:864-224-2465
Mailing Address - Fax:864-224-1146
Practice Address - Street 1:100 HEALTHY WAY
Practice Address - Street 2:SUITE 1250
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-7915
Practice Address - Country:US
Practice Address - Phone:864-224-2465
Practice Address - Fax:864-224-1146
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1168174400000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP39938Medicare UPIN
SCAA85717742Medicare PIN
SC5863Medicare PIN