Provider Demographics
NPI:1558886739
Name:GERSTENACKER, DEVONNE JEAN (NP)
Entity Type:Individual
Prefix:
First Name:DEVONNE
Middle Name:JEAN
Last Name:GERSTENACKER
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:391 SERPENTINE DR STE 400
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3081
Practice Address - Country:US
Practice Address - Phone:864-560-7517
Practice Address - Fax:864-560-7520
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC94977163W00000X
SC21296363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4732Medicaid
SCSCB4777652OtherMEDICARE PIN