Provider Demographics
NPI:1740814573
Name:VANVICK, PEYTON BATSON (FNP)
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:BATSON
Last Name:VANVICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PAYTON
Other - Middle Name:LEE
Other - Last Name:BATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:105 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5608
Practice Address - Country:US
Practice Address - Phone:864-797-7060
Practice Address - Fax:864-797-7065
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23647363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP6874Medicaid