Healthcare Provider Details

I. General information

NPI: 1710707633
Provider Name (Legal Business Name): NATALIE ROSE ANDERSON PA-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HEALTHY WAY STE 1200
ANDERSON SC
29621-7916
US

IV. Provider business mailing address

PO BOX 100174
COLUMBIA SC
29202-3174
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-6140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6307
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: