Provider Demographics
NPI:1821855602
Name:DRENNON, ERIN PRUITT (FNP - BC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:PRUITT
Last Name:DRENNON
Suffix:
Gender:F
Credentials:FNP - BC
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 1711
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-1711
Mailing Address - Country:US
Mailing Address - Phone:864-314-9214
Mailing Address - Fax:864-712-9198
Practice Address - Street 1:208 JAMES ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29625-2942
Practice Address - Country:US
Practice Address - Phone:864-314-9214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily