Provider Demographics
NPI:1669404950
Name:MYERS, MICHELLE CHAVOUS (APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHAVOUS
Last Name:MYERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 SAINT JULIAN PL STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2402
Mailing Address - Country:US
Mailing Address - Phone:803-497-9611
Mailing Address - Fax:803-764-2003
Practice Address - Street 1:1735 SAINT JULIAN PL STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2402
Practice Address - Country:US
Practice Address - Phone:803-497-9611
Practice Address - Fax:803-764-2003
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0231Medicaid
SCNP1704Medicaid
SCS68426Medicare UPIN