Provider Demographics
NPI:1811428030
Name:NURSE PRACTITIONERS OF THE CAROLINAS
Entity type:Organization
Organization Name:NURSE PRACTITIONERS OF THE CAROLINAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:LARISSA
Authorized Official - Last Name:OVERTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:803-429-7716
Mailing Address - Street 1:10120 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4395
Mailing Address - Country:US
Mailing Address - Phone:803-429-7716
Mailing Address - Fax:
Practice Address - Street 1:10120 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4395
Practice Address - Country:US
Practice Address - Phone:803-429-7716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19829313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3664Medicaid