Provider Demographics
NPI:1659393890
Name:PROSSER, DEBRA JOHNSON (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JOHNSON
Last Name:PROSSER
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 1:320 HARBISON BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-2225
Mailing Address - Country:US
Mailing Address - Phone:803-732-8370
Mailing Address - Fax:
Practice Address - Street 1:320 HARBISON BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-2225
Practice Address - Country:US
Practice Address - Phone:803-732-8370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCS86369Medicare UPIN