Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 25442 | SC |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 25442 | SC |
NPI | 1023761905 |
---|---|
Provider Name | Mrs. Mindy Allison Smith |
First Address | Lexington, SC 29072-7131 |
Second Address | West Columbia, SC 29169-2429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2022 |
Last Update Date | 03/02/2022 |