Provider Demographics
NPI:1770903098
Name:RICHMOND, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3415
Mailing Address - Country:US
Mailing Address - Phone:864-242-5872
Mailing Address - Fax:864-242-5640
Practice Address - Street 1:1501 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4734
Practice Address - Country:US
Practice Address - Phone:864-716-0063
Practice Address - Fax:864-716-0073
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPPLYING364SF0001X
SCAPPLIED363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health