Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 363LF0000X | Nurse Practitioner | Family | APN 511 | SOUTH CAROLINA | No |
| 2 | 363LX0106X | Nurse Practitioner | Occupational Health | APN 511 | SOUTH CAROLINA | No |
| 3 | 364S00000X | Clinical Nurse Specialist | | APN 511 | SOUTH CAROLINA | No |
| 4 | 363L00000X | Nurse Practitioner | | APN 511 | SOUTH CAROLINA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | S874448753 | OTHER | SOUTH CAROLINA | MEDICARE ID - AGAPE PRIMARY CARE |
| 2 | S87444 | MEDICARE UPIN | | |
| 3 | S874448163 | MEDICARE ID-TYPE UNSPECIFIED | | |
| 4 | E2083 | OTHER | | MEDCOST |
| 5 | NP0355 | MEDICAID | SOUTH CAROLINA | |