Provider Demographics
NPI:1578590675
Name:SMITH, NANCY CARROL (APRN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:CARROL
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 LESESNE DR
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-5427
Mailing Address - Country:US
Mailing Address - Phone:803-478-8838
Mailing Address - Fax:
Practice Address - Street 1:520 THURGOOD MARSHALL HWY
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4108
Practice Address - Country:US
Practice Address - Phone:843-355-6012
Practice Address - Fax:843-355-9590
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF2304363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner