Provider Demographics
NPI:1891306205
Name:PEDEN, SARAH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:PEDEN
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 1:470 HULON LANE
Mailing Address - Street 2:VP- REVENUE CYCLE
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169
Mailing Address - Country:US
Mailing Address - Phone:803-794-7511
Mailing Address - Fax:803-794-7751
Practice Address - Street 1:222 E MEDICAL LN STE 400
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4848
Practice Address - Country:US
Practice Address - Phone:803-645-0254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24272363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health