Provider Demographics
NPI:1518068980
Name:WINEBRENNER, DEREK L (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:L
Last Name:WINEBRENNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4812 BLUFFTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4602
Mailing Address - Country:US
Mailing Address - Phone:843-837-4300
Mailing Address - Fax:843-837-4304
Practice Address - Street 1:4812 BLUFFTON PKWY
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4602
Practice Address - Country:US
Practice Address - Phone:843-837-4300
Practice Address - Fax:843-837-4304
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3308363A00000X
SCTL3308363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0254907Medicare ID - Type Unspecified