Provider Demographics
NPI:1821057803
Name:CHITWOOD, DORIS L (APRN-BC)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:L
Last Name:CHITWOOD
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1393 CELANESE RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1722
Mailing Address - Country:US
Mailing Address - Phone:803-329-3103
Mailing Address - Fax:803-325-2232
Practice Address - Street 1:1393 CELANESE RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1722
Practice Address - Country:US
Practice Address - Phone:803-329-3103
Practice Address - Fax:803-325-2232
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 511363L00000X, 363LF0000X, 363LX0106X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0355Medicaid
E2083OtherMEDCOST
SCS874448753OtherMEDICARE ID - AGAPE PRIMARY CARE
SCS874448753OtherMEDICARE ID - AGAPE PRIMARY CARE
SCNP0355Medicaid