Provider Demographics
NPI:1689100653
Name:MURPHY, NICOLE PASCHAL
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:PASCHAL
Last Name:MURPHY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:NICOLE
Other - Last Name:PASCHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1632 WEDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-7665
Mailing Address - Country:US
Mailing Address - Phone:843-325-5130
Mailing Address - Fax:
Practice Address - Street 1:1632 WEDGEFIELD RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-7665
Practice Address - Country:US
Practice Address - Phone:843-325-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4600Medicaid
SC20921OtherSC FNP LICENSE