Provider Demographics
NPI:1932292067
Name:PACKARD, VICTOR W II (APRN)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:W
Last Name:PACKARD
Suffix:II
Gender:M
Credentials:APRN
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 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:391 SERPENTINE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3096
Practice Address - Country:US
Practice Address - Phone:864-560-7517
Practice Address - Fax:864-560-7520
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004021363LP0808X
TNRN0000098770163WP0809X
SC3050363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult